Spironolactone Shows Efficacy in Diastolic Heart Failure

"We saw consistent structural and functional remodeling effects from spironolactone, and except for left ventricular size, all of the other measures improved. But we saw no benefit on exercise capacity, New York Heart Association class, or quality of life," Dr. Pieske said. "Somehow, the beneficial effects on the heart did not translate into an improved situation."

While the overall safety profile of spironolactone treatment was good, the results showed a few possible areas of concern. In the spironolactone group, 36% of patients had worsening renal function, compared with 21% in the control arm, a significant difference; and the average GFR fell by about 7 mL/min per 1.73 m² with spironolactone, compared with no change in the control patients. The incidence of new or worsening anemia was 16% among the spironolactone patients and 9% in the controls, a significant difference. And twice as many patients on spironolactone had an increase in their serum potassium compared with the controls. However, the incidence of severe hyperkalemia was low and similar in both arms of the study.

"To our knowledge, increased anemia was not seen before" with spironolactone. "Maybe the anemia or a mild decrease in hemoglobin contributed" to the lack of an effect of treatment on exercise capacity, Dr. Pieske suggested.

Aldo-DHF was sponsored by the German government. Dr. Pieske said that he and his associates had no disclosures. Dr. Anker said that he has received consulting fees from Amgen, Bosch Healthcare, and other companies.