Heart and Vessels

, Volume 34, Issue 2, pp 279–289 | Cite as

Comparison of effects of aldosterone receptor antagonists spironolactone and eplerenone on cardiovascular outcomes and safety in patients with acute decompensated heart failure

  • Masayoshi Yamamoto
  • Yoshihiro SeoEmail author
  • Tomoko Ishizu
  • Isao Nishi
  • Yoshie Hamada-Harimura
  • Tomoko Machino-Ohtsuka
  • Haruhiko Higuchi
  • Seika Sai
  • Tomofumi Nakatsukasa
  • Akinori Sugano
  • Masako Baba
  • Kenichi Obara
  • Kazutaka Aonuma
Original Article


Differences in the clinical impacts of the aldosterone receptor antagonists spironolactone and eplerenone in patients with heart failure (HF) are unclear. Among 838 prospectively enrolled patients hospitalized for HF, 90 treated with eplerenone were compared with 90 treated with spironolactone. The primary endpoint was a composite of cardiovascular death and hospitalization. A serial evaluation of the clinical parameters was performed 1 year after discharge. The mean dose of spironolactone was 27 ± 8 mg and of eplerenone was 34 ± 15 mg. During follow-up (mean 594 ± 317 days), primary endpoints occurred in 27 patients in the eplerenone group (30.0%) and 25 patients in the spironolactone group (27.8%). There were no significant intergroup differences in the primary endpoint (log-rank, p = 0.956). Serial changes in left ventricular ejection fraction, serum brain natriuretic peptide, systolic blood pressure, and estimated glomerular filtration rate did not differ significantly between groups. Although gynecomastia in men was common in the spironolactone group (p = 0.018), the discontinuation rates due to adverse events were similar in the two groups (p = 0.135). Subgroup analyses suggested that eplerenone was associated with a lower hazard rate of the primary endpoint in female patients (interaction, p = 0.076). Among patients with HF, eplerenone and spironolactone have similar impacts on cardiovascular outcomes and safety.


Aldosterone receptor antagonist Spironolactone Eplerenone Heart failure 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Masayoshi Yamamoto
    • 1
  • Yoshihiro Seo
    • 1
    Email author
  • Tomoko Ishizu
    • 1
  • Isao Nishi
    • 2
  • Yoshie Hamada-Harimura
    • 3
  • Tomoko Machino-Ohtsuka
    • 1
  • Haruhiko Higuchi
    • 4
  • Seika Sai
    • 3
  • Tomofumi Nakatsukasa
    • 1
  • Akinori Sugano
    • 1
  • Masako Baba
    • 5
  • Kenichi Obara
    • 6
  • Kazutaka Aonuma
    • 1
  1. 1.Department of Cardiology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
  2. 2.Department of Cardiology, Tsuchiura Clinical Education and Training CenterUniversity of Tsukuba HospitalTsukubaJapan
  3. 3.Department of Cardiology, Graduate School of Comprehensive Human SciencesUniversity of TsukubaTsukubaJapan
  4. 4.Department of CardiologyHitachi, Ltd, Hitachi General HospitalHitachinakaJapan
  5. 5.Department of CardiologyIbaraki Prefectural Central HospitalKasamaJapan
  6. 6.Division of CardiologyRyugasaki Saiseikai General HospitalRyugasakiJapan

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