Clinical effect of low-dose spironolactone on severe heart failure

Objective: To study the curative effect of low-dose spironolactone on severe heart failure. Methods: In a randomized double-blind study, 81 patients with severe heart failure (NYHA class Ⅲ-Ⅳ and a left ventricular ejection fraction less than 35%) were enrolled and treated by anti-heart failure. In twelve months, the treatment group received 20 mg of spironolactone daily, while the control group did placebo. Serum levels of creatinine, urea nitrogen, potassium, changes of pulse and blood pressure were measured periodically. Holter monitoring was used to assess the ventricular arhythmia. And finally, the mortality of the patients was calculated. Results: The incidences of hyperkalemia in the control and the treatment group were 5% and 9.8% respectively. Compared with those in the control group, systolic and diastolic arterial pressures decreased and serum levels of creatinine and urea nitrogen did not significantly change in the treatment group. Holter monitoring analysis indicated that in one year there was an apparently decrease in the hourly frequency of ventricular premature complexes (P0.0001) and episodes of nonsustained ventricular tachycardia. In a year 18(45%) and 11 (26.8%) cases died in the control group and spironolactone treatment group, there was 38% percent reduction in the risk of death ratio among them(P0.05). Conclusion: Low-dose spironolactone (20 mg/d) can be used in the treatment for patients with severe heart failure, which has minimal adverse effects and is effective in reversing the reconstruction of the heart, and thus reduces the mortality of the patients with severe heart failure.