Spironolactone improves left atrial function and atrioventricular coupling in patients with resistant hypertension

• Published in: The international journal of cardiovascular imaging Vol. 40; no. 3; pp. 487 - 497
• Main Authors: Girard, Andrew A., Denney, Thomas S., Gupta, Himanshu, Dell’Italia, Louis J., Calhoun, David A., Oparil, Suzanne, Sharifov, Oleg F., Lloyd, Steven G.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.03.2024; Springer Nature B.V
• Subjects: Aldosterone; Antihypertensives; Blood pressure; Cardiac Imaging; Cardiology; Coupling; Hypertension; Imaging; Magnetic resonance imaging; Medicine; Medicine & Public Health; Mineralocorticoid receptors; Original Paper; Pressure effects; Radiology; Renin; Left atrioventricular coupling index; Left atrial function; Left atrial strain; Cardiovascular magnetic resonance; Resistant hypertension; Left atrial structure
• ISSN: 1875-8312; 1569-5794; 1875-8312; 1573-0743
• DOI: 10.1007/s10554-023-03013-7

To determine the blood pressure independent effects of spironolactone on left atrial (LA) size and function in patients with resistant hypertension (RHTN). Patients with RHTN (n = 36, mean age 55 ± 7) were prospectively recruited. Spironolactone was initiated at 25 mg/day and increased to 50 mg/day after 4 weeks. Other antihypertensives were withdrawn to maintain constant blood pressure. Cardiac magnetic resonance imaging was performed at baseline and after 6 months of spironolactone treatment and changes in LA functional metrics were assessed. LA size and function parameters were improved (p < 0.05) from baseline to month-6: LA volumes indexed to body surface area (LAVI) were reduced (LAVI maximum 41.4 ± 12 vs. 33.2±9.7 mL/m 2 ; LAVI pre-A 32.6 ± 9.8 vs. 25.6 ± 8.1 mL/m 2 ; median LAVI minimum 18.5 [13.9–24.8] vs. 14.1 [10.9–19.2] mL/m 2 ); left atrioventricular coupling index was reduced (28.2 ± 11.5 vs. 22.7 ± 9.2%); LA emptying fractions (LAEF) were increased (median total LAEF 52.4 [48.7–60.3] vs. 55.9 [50.3–61.1] %; active LAEF 40.2 ± 8.6 vs. 43.1 ± 7.8%). LA global longitudinal strain in the active phase was increased (16.3 ± 4.1 vs. 17.8 ± 4.2%). The effect of spironolactone was similar in patients with high (N = 18) and normal (N = 18) aldosterone status (defined by plasma renin activity and 24-h urine aldosterone). Treatment of RHTN with spironolactone is associated with improvements in LA size and function, and atrioventricular coupling, regardless of whether aldosterone levels were normal or high at baseline. This study suggests the need for larger prospective studies examining effects of mineralocorticoid receptor antagonists on atrial function and atrioventricular coupling.