Impact of spironolactone on vascular, myocardial, and functional parameters in untreated patients with a hypertensive response to exercise

James L. Hare, James E. Sharman, Rodel Leano, Carly Jenkins, Leah Wright, Thomas H. Marwick

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Background Although a hypertensive response to exercise (HRE) is associated with cardiac risk and masked hypertension (MHT), its mechanisms and appropriate treatment remain unclear. We investigated spironolactone as a treatment for abnormal vascular and myocardial stiffness in HRE. Methods In this randomized, double-blind, placebo-controlled study of 115 patients (54±9 years, 57% men) with an HRE (≥210/105mm Hg in men; ≥190/105mm Hg in women) but no prior history of hypertension or myocardial ischemia, MHT prevalence was 40%. Patients were randomized to spironolactone 25mg daily (n = 58) or placebo (n = 57) and underwent evaluation at baseline and 3 months with exercise echocardiography, VO2max, pulse wave velocity (PWV), exercise and central blood pressure (BP), and 24-hour ambulatory BP. Changes in left ventricular mass index (LVMI), Doppler-derived E/em ratio (LV filling pressure), and myocardial strain were assessed. Results Baseline 24-hour systolic BP (SBP) was 133±10mm Hg and peak-exercise SBP was 219±16mm Hg. Peak systolic strain (0.3±3.6% vs.-0.1±3.2, P = 0.56), E/em (-1.1±2.3 vs.-0.6±1.7, P = 0.30), VO 2max (0.4±4.9 vs.-0.9±4.1ml/kg/min, P = 0.15), and adjusted PWV did not significantly change with treatment, despite reduction in exercise SBP, 24-hour SBP, and LVMI. The change in exercise E/em was of borderline significance (-0.3±2.4 vs. 0.8±2.8, P = 0.06) and became significant after adjustment for baseline differences (P = 0.01). Patients with higher LVMI significantly increased VO2max (1.1±5.6 vs.-2.4±4.4ml/kg/min, P < 0.05) and reduced exercise E/em (-0.7±2.7 vs. 1.9±2.8, P < 0.05). Conclusions In HRE patients without previous hypertension, short-term spironolactone reduced exercise BP, 24-hour ambulatory BP, LVMI, and E/em but did not significantly alter exercise capacity or myocardial strain.

Original languageEnglish
Pages (from-to)691-699
Number of pages9
JournalAmerican Journal of Hypertension
Issue number5
Publication statusPublished - May 2013
Externally publishedYes


  • aldosterone antagonist
  • blood pressure
  • echocardiography
  • exercise
  • hypertension
  • left ventricular hypertrophy

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