Endothelial dysfunction is highly prevalent and associated with adverse outcomes among patients without obstructive coronary artery disease (CAD). Angiotensin II inhibition may improve endothelial function, but with continued treatment, “aldosterone escape” may occur. Thus, it is unknown if adding aldosterone blockade further improves endothelial function. In a double-blind, parallel-group, repeated-measures study, women with symptoms and signs of ischemia, no significant CAD, and coronary endothelial dysfunction receiving an angiotensin-converting enzyme inhibitor or receptor blocker were randomized to aldosterone blockade or placebo. The primary outcome at 16 weeks was percent change in coronary diameter to acetylcholine, and secondary outcome, coronary flow reserve to adenosine, both adjusted for baseline reactivity. Adding aldosterone receptor blockade to angiotensin II inhibition did not improve coronary endothelial or microvascular function among women with signs and symptoms of ischemia in the setting of nonobstructive CAD.
Authors: Anthony A Bavry, Eileen M Handberg, Tianyao Huo, Amir Lerman, Arshed A Quyyumi, Chrisandra Shufelt, Barry Sharaf, C Noel Bairey Merz, Rhonda M Cooper-DeHoff, George Sopko, Carl J Pepine
Keywords: endothelium, vascular, eplerenone, female, women, mineralocorticoid receptor antagonist, spironolactone, vasodilation, coronary artery disease, gender
DOI Number: 10.1016/j.ahj.2014.01.017 Publication Year: 2014
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