Clinical effect of low-dose spironolactone on severe heart failure

Objective To study the curative effect of low dose spironolactone to severe heart failureMethods In a randomized double blind study we enrolled 85 patients with severe heart failure (NYHA class Ⅲ Ⅳ and a left ventricular ejection fraction less than 35%). They were treated by anti heurt failure.The treatmet group treatment received 20 mg of spironolactone daily,and the control group received placebo.All the procedures had been performed for 12 months.Serum levels of creatinine,ureanitrogen and potassium and the changes of pulse and blood pressure were measured periodically.Holter monitoring was used to assess the ventricular arrhythmia.And at last the mortality rate of the patients was calculated.Results The incidence of hyperkalemia in the control group and the treatment group were 4.8% and 9.3%,respectively. Compared with the control group,systolic and diastolic arterial pressure decreased and serum levels of creatinine and urea nitrogen did not significantly change in the treatment group.Hotler minitoring analysis in one year there was apparently decrease in the hourly frequency of ventricular premature complexes(P0.0001)and episodes of nonsustained ventricular tachycardia.In a year 19(45.2%)and 12(27.8%)cases died in the controt group and spironolacton the 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 of patients with severe heart failure. It has minimal adverse effects and is effective in reversing the reconstruction of the heart and blood vessels, therefore it is effective in reducing the mortality rate of the cases with severe heart failure.