The Effect of Spironolactone on Morbidity and Mortality in Patients With Severe Heart Failure


Aldosterone is important in the pathophysiology of heart failure. In a double-blind study, we enrolled 1663 patients who had severe heart failure and a left ventricular ejection fraction of no more than 35 percent and who were being treated with an angiotensin-converting-enzyme inhibitor, a loop diuretic, and in most cases digoxin. A total of 822 patients were randomly assigned to receive 25 mg of spironolactone daily, and 841 to receive placebo. The primary end point was death from all causes. Blockade of aldosterone receptors by spironolactone, in addition to standard therapy, substantially reduces the risk of both morbidity and death among patients with severe heart failure.

Authors: Bertram Pitt, Faiez Zannad, Willem J. Remme, Robert Cody, Alain Castaigne, Alfonso Perez, Jolie Palensky, Janet Wittes
Keywords: Spironolactone, ACE inhibitors, loop diuretics
DOI Number: 10.1056/NEJM199909023411001      Publication Year: 1999

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