Spironolactone Versus Eplerenone as Adjunctive Treatment in Patients with Heart Failure
Abstract
Mohammad A K Hasan, Hossam Kandi
Background: The goals of treatment in patients with heart failure (HF) are to improve their clinical status, functional capacity, and quality of life, prevent hospital admission and reduce mortality.
Aim of the work: This work aims to evaluate spironolactone versus eplerenone as an adjunctive therapy regarding tolerability in patients with HF (NYHA II to IV) already on anti-failure treatment with beta Blockers (BB) and/or ivabradine and their effect on major adverse cardiac events.
Study design: 100 patients were recruited and randomized into 2 groups (n=50/group); group 1 received spironolactone 25mg/d that was titrated to 100mg/d if tolerated, while group 2 received eplerenone 25mg/d that was titrated to 50mg/d if tolerated. Follow up of: symptoms, signs, potassium level, BNP, renal functions, systolic function and side effects was done over 3 months in 3 visits.
Results: After 3 months it was found that 39 patients (78%) in each group showed good or marked improvement, with non significant P-value. Regarding side effects, the spironolactone group showed incidence of hyperkalemia in 6 patients (12%) in the spironolactone group; with 0% incidence in the other group with significant P-value (P<0.001). On the other hand 5 patients (10%) had gynecomastia in the spironolactone group with 0% incidence in the eplerenone group with significant P-value (P<0.001).
Conclusion: spironolactone and eplerenone are both effective but the eplerenone is much more safer than spironolactone when added as an adjunctive therapy in patients with HF and are kept on full medical therapy including BBs.