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David A. Calhoun - One of the best experts on this subject based on the ideXlab platform.

  • Use of Aldosterone Antagonists for Treatment of Uncontrolled Resistant Hypertension.
    American journal of hypertension, 2016
    Co-Authors: Tanja Dudenbostel, David A. Calhoun
    Abstract:

    Background Multiple studies indicate that primary aldosteronism (PA) is common in patients with resistant hypertension, with an estimated prevalence of approximately 20%. Additional studies suggest that beyond this 20% of patients with classical PA, there is a larger proportion of patients with lesser degrees of hyperaldosteronism which contributes even more broadly to antihypertensive treatment resistance. Given these observations, it is intuitive that use of Aldosterone Antagonists will provide antihypertensive benefit in patients with resistant hypertension and evidence of Aldosterone excess. Intriguingly, however, are clinical findings demonstrating substantive benefit of Aldosterone Antagonists in patients with resistant hypertension, but without demonstrative evidence of hyperaldosteronism, that is, with seemingly normal or even low Aldosterone levels. Conclusion Spironolactone is clearly established as the most effective fourth agent for treatment of uncontrolled resistant hypertension. Emerging observations suggest a further role of spironolactone for counteracting the effects of diet high in sodium, particularly in obese, hypertensive patients.

  • Use of Aldosterone Antagonists in Resistant Hypertension
    Progress in Cardiovascular Diseases, 2006
    Co-Authors: David A. Calhoun
    Abstract:

    Resistant hypertension is defined as an elevated blood pressure in spite of treatment with 3 different antihypertensive agents. The prevalence of resistant hypertension is unknown, but recent cross-sectional analyses and hypertension outcome studies suggest it is a common clinical problem and will become even more so with an aging and increasingly heavy population. Secondary causes of hypertension are common in patients with resistant hypertension, in particular, obstructive sleep apnea and hyperaldosteronism. Treatment of resistant hypertension is predicated upon identification and reversal of secondary causes of hypertension, as possible, and effective use of multidrug regimens. Recent clinical studies indicate that Aldosterone Antagonists, spironolactone and amiloride, provide significant additional blood pressure reduction when added to treatment regimens of patients with resistant hypertension. Both agents are generally well tolerated. Hyperkalemia is an uncommon complication of Aldosterone Antagonists, but it can occur; therefore, biochemical monitoring is necessary, particularly in high-risk patients.

  • Aldosterone Antagonists: effective add-on therapy for the treatment of resistant hypertension.
    Expert review of cardiovascular therapy, 2006
    Co-Authors: Krishna K. Gaddam, Monique N. Pratt-ubunama, David A. Calhoun
    Abstract:

    Resistant hypertension is defined as blood pressure that remains above target levels despite treatment with three different antihypertensive agents. Cross-sectional analyses and hypertension outcome studies indicate that it is a common clinical problem, which will undoubtedly become increasingly prevelant with an aging and increasingly overwight population. Secondary causes of hypertension are common in patients with resistant hypertension, particularly hyperaldosteronism, with a prevalence of approximately 15–20%. This, however, is likely to be an underestimation of the role excess Aldosterone plays in causing resistance to treatment. In subjects with resistant hypertension, suppressed renin levels are common, exceeding 60% in studies conducted by the authors and from centers elsewhere in the world, suggesting occurrence of excess Aldosterone beyond cases of true primary aldosteronism. Recent clinical studies indicate that Aldosterone Antagonists provide significant additional blood pressure reduction wh...

  • The role of Aldosterone Antagonists in the management of resistant hypertension.
    Current Hypertension Reports, 2005
    Co-Authors: Mari K. Nishizaka, David A. Calhoun
    Abstract:

    Resistant hypertension is an increasingly common problem faced by primary care physicians and specialists and will undoubtedly become even more common as the adult population ages and gains weight. In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), at least 8% of subjects were resistant to treatment based on the need for three or more antihypertensive agents. Characteristics of patients with resistant hypertension include being older, black, obese, and diabetic, and having chronic kidney disease as well as untreated sleep apnea. Hyperaldosteronism is common in patients with resistant hypertension, with a prevalence of approximately 20%. This, however, is likely an underestimation of the role Aldosterone excess plays in causing drug resistance. In subjects with resistant hypertension, suppressed renin levels are common, exceeding 75% in our studies, suggesting Aldosterone excess effects beyond cases of true primary hyperaldosteronism. Recent studies indicate that Aldosterone Antagonists provide significant blood pressure reduction when added to antihypertensive regimens of patients with resistant hypertension. Interestingly, the blood pressure reduction with use of spironolactone is not limited to patients with hyperaldosteronism, consistent with the concept of Aldosterone excess as a continuum from low-renin hypertension with normal Aldosterone levels to true primary hyperaldosteronism.

  • use of Aldosterone Antagonists in resistant hypertension
    Journal of Clinical Hypertension, 2004
    Co-Authors: Mari K. Nishizaka, David A. Calhoun
    Abstract:

    Recent clinical trials indicate that resistant hypertension, defined as uncontrolled hypertension despite concomitant use of three or more antihypertensive agents, is common, affecting 20%-30% of the different study populations. Such clinical outcome studies provide our best estimates of the true frequency of resistant hypertension because they employed an intensive treatment regimen mandating drug titrations if blood pressure remained elevated, medications were provided at no charge, and adherence was closely monitored with pill counts. Given the size and diversity of the study population, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)[1] may provide the best estimation of the prevalence of resistant hypertension. In ALLHAT, more than 33,000 subjects aged 55 years or older with a history of hypertension and one other cardiovascular risk factor were randomized to chlorthalidone, amlodipine, or lisinopril. The dose of the randomized medication was titrated first; nonstudy antihypertensive medications were then added as long as blood pressure remained above 140/90 mm Hg. After 5 years of follow-up, 34% of subjects had not achieved goal blood pressure and overall, 27% of subjects were receiving three or more medications.[1]

Debra L. Zynger - One of the best experts on this subject based on the ideXlab platform.

  • Adrenal gland inclusions in patients treated with Aldosterone Antagonists (Spironolactone/Eplerenone): incidence, morphology, and ultrastructural findings
    Diagnostic pathology, 2014
    Co-Authors: Kishan Patel, Edward Calomeni, Tibor Nadasdy, Debra L. Zynger
    Abstract:

    Spironolactone is often used to treat hypertension caused by hyperaldosteronism, and as a result, can form concentrically laminated electron dense spironolactone body inclusions within the adrenal gland. Spironolactone bodies have not been investigated in a contemporary cohort or in patients treated with the more recently approved Aldosterone antagonist, eplerenone. Spironolactone bodies were retrospectively investigated in patients treated for hyperaldosteronism (n = 15) from 2012-2013 that underwent a subsequent adrenalectomy. Inclusions were identified in 33% of patients treated with Aldosterone Antagonists, far less than previously reported. Remarkably, 50% of patients treated with spironolactone had inclusions while no patients using eplerenone alone had inclusions. Two patients treated with spironolactone had bodies present longer than the duration described in prior studies. Inclusions unexpectedly persisted in 1 patient despite increased duration of discontinued pharmacological treatment. A spectrum of histologic and ultrastructural findings were encountered within an adrenal cortical adenoma from a patient treated with both spironolactone and eplerenone. Ultrastructural examination revealed laminated electron dense bodies with the appearance of classic spironolactone inclusions as well as electron dense bodies without laminations and laminated bodies without electron dense cores. Our incidence rate of spironolactone bodies was much lower than previously reported, with no inclusions seen in patients treated solely with the newer Aldosterone antagonist, eplerenone. Pathologists should be aware of these infrequently encountered inclusions, particularly as the clinical history of hyperaldosteronism and pharmacologic treatment may not be provided. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4597918761268031

  • adrenal gland inclusions in patients treated with Aldosterone Antagonists spironolactone eplerenone incidence morphology and ultrastructural findings
    Diagnostic Pathology, 2014
    Co-Authors: Kishan Patel, Edward Calomeni, Tibor Nadasdy, Debra L. Zynger
    Abstract:

    Spironolactone is often used to treat hypertension caused by hyperaldosteronism, and as a result, can form concentrically laminated electron dense spironolactone body inclusions within the adrenal gland. Spironolactone bodies have not been investigated in a contemporary cohort or in patients treated with the more recently approved Aldosterone antagonist, eplerenone. Spironolactone bodies were retrospectively investigated in patients treated for hyperaldosteronism (n = 15) from 2012-2013 that underwent a subsequent adrenalectomy. Inclusions were identified in 33% of patients treated with Aldosterone Antagonists, far less than previously reported. Remarkably, 50% of patients treated with spironolactone had inclusions while no patients using eplerenone alone had inclusions. Two patients treated with spironolactone had bodies present longer than the duration described in prior studies. Inclusions unexpectedly persisted in 1 patient despite increased duration of discontinued pharmacological treatment. A spectrum of histologic and ultrastructural findings were encountered within an adrenal cortical adenoma from a patient treated with both spironolactone and eplerenone. Ultrastructural examination revealed laminated electron dense bodies with the appearance of classic spironolactone inclusions as well as electron dense bodies without laminations and laminated bodies without electron dense cores. Our incidence rate of spironolactone bodies was much lower than previously reported, with no inclusions seen in patients treated solely with the newer Aldosterone antagonist, eplerenone. Pathologists should be aware of these infrequently encountered inclusions, particularly as the clinical history of hyperaldosteronism and pharmacologic treatment may not be provided. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4597918761268031

Gregg C. Fonarow - One of the best experts on this subject based on the ideXlab platform.

  • Effectiveness and Safety of Aldosterone Antagonist Therapy Use Among Older Patients With Reduced Ejection Fraction After Acute Myocardial Infarction.
    Journal of the American Heart Association, 2016
    Co-Authors: Tracy Y. Wang, Gregg C. Fonarow, James A De Lemos, Sandeep R Das, Amit N. Vora, S. Andrew Peng, Eric D Peterson
    Abstract:

    Background While Aldosterone Antagonists have proven benefit among post‐myocardial infarction (MI) patients with low ejection fraction (EF), how this treatment is used among older MI patients in routine practice is not well described. Methods and Results Using ACTION Registry‐GWTG linked to Medicare data, we examined 12 080 MI patients ≥65 years with EF ≤40% who were indicated for Aldosterone antagonist therapy per current guidelines and without documented contraindications. Of these, 11% (n=1310) were prescribed Aldosterone Antagonists at discharge. Notably, 10% of patients prescribed an Aldosterone antagonist were eligible for, but not concurrently treated with, an angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker. Spironolactone was the predominantly prescribed Aldosterone antagonist. At 2‐year follow‐up, Aldosterone antagonist use was not associated with lower mortality (unadjusted 39% versus 38%; HR 0.99, 95% CI 0.88–1.33 using inverse probability‐weighted propensity adjustment) except in symptomatic HF patients (HR 0.84, 95% CI 0.72–0.99, P interaction =0.009). Risks of hyperkalemia were low at 30 days, but significantly higher among patients prescribed Aldosterone Antagonists (unadjusted 2.3% versus 1.5%; adjusted HR 2.04, 95% CI 1.16–3.60), as was 2‐year risk of acute renal failure (unadjusted 6.7% versus 4.8%; adjusted HR 1.39, 95% CI 1.01–1.92) compared with patients not prescribed Aldosterone Antagonists. Conclusions Aldosterone antagonist use among eligible older MI patients in routine clinical practice was not associated with lower mortality except in patients with HF symptoms, but was associated with increased risks of hyperkalemia and acute renal failure. These results underscore the importance of close post‐discharge monitoring of this patient population.

  • use of Aldosterone Antagonists at discharge after myocardial infarction results from the national cardiovascular data registry acute coronary treatment and intervention outcomes network action registry get with the guidelines gwtg
    American Heart Journal, 2013
    Co-Authors: Krishnasree Rao, Gregg C. Fonarow, Jonathan R Enriquez, James A De Lemos, Karen P Alexander, Anita Y Chen, Darren K Mcguire, Sandeep R Das
    Abstract:

    Background Aldosterone Antagonists (AldA) improve survival after myocardial infarction (MI) in patients with left ventricular systolic dysfunction (ejection fraction [EF] Methods Using data from the National Cardiovascular Data Registry ACTION Registry-GWTG, we describe contemporary discharge AldA prescription patterns among 202,213 patients discharged after acute MI from 526 US sites participating in ACTION Registry-GWTG between January 2007 and March 2011. Results Overall, 10.0% of patients were eligible for AldA without documented contraindication, with only 14.5% of eligible patients receiving AldA at discharge. Among the subset of AldA-eligible patients discharged on otherwise optimal medical therapy (68.9%), AldAs were prescribed to 16.1%. Aldosterone antagonist use was higher in patients with EF P Conclusions Despite clinical outcome evidence and class I guideline recommendations, AldAs are underused in the United States, with only 1 in 7 eligible patients prescribed AldA at discharge after MI. This contrasts with high use of other evidence-based post-MI medications and identifies a specific gap in translation of evidence into clinical practice.

  • temporal trends and predictors in the use of Aldosterone Antagonists post acute myocardial infarction
    Journal of the American College of Cardiology, 2013
    Co-Authors: Andrew N Rassi, Gregg C. Fonarow, Adrian F Hernandez, Eric D Peterson, Christopher P Cannon, Matthew A Cavender, Frank W Peacock, Warren K Laskey, Sylvia E Rosas, Xin Zhao
    Abstract:

    Objectives This study explored temporal trends in the use of Aldosterone antagonist therapy among eligible patients with post-acute myocardial infarction (AMI) and reduced ejection fraction and characteristics associated with use in clinical practice. Background Current guidelines recommend initiation of Aldosterone antagonist therapy post-AMI for patients with an ejection fraction ≤40% and heart failure or diabetes before hospital discharge, in the absence of contraindications. Methods Data from the American Heart Association's Get with the Guidelines–Coronary Artery Disease national database were analyzed for 81,570 post-AMI patients from 219 hospitals between 2006 and 2009, of whom 11,255 (13.8%) were eligible for Aldosterone antagonist therapy. Results Among eligible patients, 1,023 (9.1%) were prescribed an Aldosterone antagonist at discharge. Aldosterone antagonist use varied from 0% to 40% among hospitals. Patient and hospital characteristics independently associated with prescription of Aldosterone Antagonists were a history of diabetes, heart failure, coronary revascularization, and larger hospital size. Those with a history of kidney dysfunction, tobacco abuse, and higher ejection fraction were less likely to be prescribed an Aldosterone antagonist. From 2006 to 2009, the use of Aldosterone Antagonists increased from 6.0% to 13.4% (p Conclusions Although rates of Aldosterone antagonist use are increasing slightly over time, the vast majority of AMI patients eligible for treatment fail to receive it at hospital discharge. The reason for this discrepancy between guideline-based therapy and actual prescribing patterns is unclear and should be further studied.

  • Aldosterone Antagonists and outcomes in real-world older patients with heart failure and preserved ejection fraction.
    JACC. Heart failure, 2013
    Co-Authors: Kanan Patel, Gregg C. Fonarow, Dalane W. Kitzman, Inmaculada Aban, Thomas E. Love, Richard M. Allman, Mihai Gheorghiade, Ali Ahmed
    Abstract:

    Objectives The purpose of this study was to examine the clinical effectiveness of Aldosterone Antagonists in older patients with heart failure and preserved ejection fraction (HF-PEF). Background Aldosterone Antagonists improve outcomes in HF and reduced EF. However, their role in HF-PEF remains unclear. Methods Of the 10,570 hospitalized older (≥65 years of age) HF-PEF (EF ≥40%) patients in the Medicare-linked OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) trial, 8,013 patients had no prior Aldosterone antagonist use and no current contraindications; 492 (6% of these 8,013) patients received new prescriptions for Aldosterone Antagonists. We assembled a matched cohort of 487 pairs of patients receiving and not receiving Aldosterone Antagonists, who had a similar propensity to receive these drugs and were balanced on 116 baseline characteristics. Results Patients had a mean age of 80 years old, a mean EF of 54%, 59% were women, and 8% were African American. During 2.4 year of mean follow-up (through December 2008), the primary composite endpoint of all-cause mortality or HF hospitalization occurred in 392 (81%) and 393 (81%) patients receiving and not receiving Aldosterone Antagonists, respectively (hazard ratio [HR]: 0.97; 95% confidence interval [CI]: 0.84 to 1.11; p = 0.628). Aldosterone Antagonists had no association with all-cause mortality (HR: 1.03; 95% CI: 0.89 to 1.20; p = 0.693) or HF hospitalization (HR: 0.88; 95% CI: 0.73 to 1.07; p = 0.188). Among 8013 prematched patients, multivariable-adjusted HR for the primary composite endpoint associated with Aldosterone antagonist use was 0.93 (95% CI: 0.83 to 1.03; p = 0.144). Conclusions In older HF-PEF patients, Aldosterone Antagonists had no association with clinical outcomes. Findings from the ongoing randomized controlled TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial will provide further insights into their effect in HF-PEF.

  • Abstract 227: Aldosterone Antagonists in Post-Acute Myocardial Infarction Use, Predictors, and Temporal Trends of a Class I Recommendation
    Circulation-cardiovascular Quality and Outcomes, 2012
    Co-Authors: Andrew N Rassi, Gregg C. Fonarow, Xin Zhao, Adrian F Hernandez, Eric D Peterson, Christopher P Cannon, Matthew A Cavender, Warren K Laskey, William F. Peacock, Lee H. Schwamm
    Abstract:

    Objectives: To measure the use of guideline-recommended Aldosterone antagonist therapy in eligible patients with post-MI and reduced ejection fraction (EF), temporal trends, and characteristics associated with use. Background: Current guidelines recommend the initiation of Aldosterone antagonist therapy post-AMI for those with an EF ≤ 40% with heart failure or diabetes prior to hospital discharge, in the absence of contraindications. We explored the relationship between this Class IA recommendation issued in 2004 (STEMI)/2007 (NSTEMI) and its implementation into practice. Methods: Data from the AHA’s Get with the Guidelines-CAD national database were analyzed for 81,570 post-AMI patients from 219 hospitals between January 1, 2006 and December 29, 2009 of whom 11,255 (13.8%) were eligible for Aldosterone antagonist therapy. Results: Among eligible patients, 1023 (9.1%) were prescribed an Aldosterone antagonist at discharge. There was wide variation in use among hospitals (0% to 40.0) with no hospital treating even half their eligible patients. Patient and hospital characteristics independently associated with prescription of Aldosterone Antagonists were history of diabetes, heart failure, or coronary revascularization. Conversely, patients less likely to have an Aldosterone antagonist prescribed had a history of renal insufficiency, were smokers, and had higher EF. Larger hospital size was associated with higher Aldosterone antagonist use. Prescription of an Aldosterone antagonist increased in the study population from 6.0% to 13.4% from January 2006 to December 2009 (p Conclusions: Fewer than one in ten post-MI patients eligible for an Aldosterone antagonist, were discharged with this Class IA recommended therapy. Although rates of utilization are rising modestly over time, compliance continues to be extremely low. This discrepancy between evidence based therapy and actual prescribing patterns suggests the need for specific targeted performance improvement efforts.

Kishan Patel - One of the best experts on this subject based on the ideXlab platform.

  • Adrenal gland inclusions in patients treated with Aldosterone Antagonists (Spironolactone/Eplerenone): incidence, morphology, and ultrastructural findings
    Diagnostic pathology, 2014
    Co-Authors: Kishan Patel, Edward Calomeni, Tibor Nadasdy, Debra L. Zynger
    Abstract:

    Spironolactone is often used to treat hypertension caused by hyperaldosteronism, and as a result, can form concentrically laminated electron dense spironolactone body inclusions within the adrenal gland. Spironolactone bodies have not been investigated in a contemporary cohort or in patients treated with the more recently approved Aldosterone antagonist, eplerenone. Spironolactone bodies were retrospectively investigated in patients treated for hyperaldosteronism (n = 15) from 2012-2013 that underwent a subsequent adrenalectomy. Inclusions were identified in 33% of patients treated with Aldosterone Antagonists, far less than previously reported. Remarkably, 50% of patients treated with spironolactone had inclusions while no patients using eplerenone alone had inclusions. Two patients treated with spironolactone had bodies present longer than the duration described in prior studies. Inclusions unexpectedly persisted in 1 patient despite increased duration of discontinued pharmacological treatment. A spectrum of histologic and ultrastructural findings were encountered within an adrenal cortical adenoma from a patient treated with both spironolactone and eplerenone. Ultrastructural examination revealed laminated electron dense bodies with the appearance of classic spironolactone inclusions as well as electron dense bodies without laminations and laminated bodies without electron dense cores. Our incidence rate of spironolactone bodies was much lower than previously reported, with no inclusions seen in patients treated solely with the newer Aldosterone antagonist, eplerenone. Pathologists should be aware of these infrequently encountered inclusions, particularly as the clinical history of hyperaldosteronism and pharmacologic treatment may not be provided. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4597918761268031

  • adrenal gland inclusions in patients treated with Aldosterone Antagonists spironolactone eplerenone incidence morphology and ultrastructural findings
    Diagnostic Pathology, 2014
    Co-Authors: Kishan Patel, Edward Calomeni, Tibor Nadasdy, Debra L. Zynger
    Abstract:

    Spironolactone is often used to treat hypertension caused by hyperaldosteronism, and as a result, can form concentrically laminated electron dense spironolactone body inclusions within the adrenal gland. Spironolactone bodies have not been investigated in a contemporary cohort or in patients treated with the more recently approved Aldosterone antagonist, eplerenone. Spironolactone bodies were retrospectively investigated in patients treated for hyperaldosteronism (n = 15) from 2012-2013 that underwent a subsequent adrenalectomy. Inclusions were identified in 33% of patients treated with Aldosterone Antagonists, far less than previously reported. Remarkably, 50% of patients treated with spironolactone had inclusions while no patients using eplerenone alone had inclusions. Two patients treated with spironolactone had bodies present longer than the duration described in prior studies. Inclusions unexpectedly persisted in 1 patient despite increased duration of discontinued pharmacological treatment. A spectrum of histologic and ultrastructural findings were encountered within an adrenal cortical adenoma from a patient treated with both spironolactone and eplerenone. Ultrastructural examination revealed laminated electron dense bodies with the appearance of classic spironolactone inclusions as well as electron dense bodies without laminations and laminated bodies without electron dense cores. Our incidence rate of spironolactone bodies was much lower than previously reported, with no inclusions seen in patients treated solely with the newer Aldosterone antagonist, eplerenone. Pathologists should be aware of these infrequently encountered inclusions, particularly as the clinical history of hyperaldosteronism and pharmacologic treatment may not be provided. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4597918761268031

Khagendra Dahal - One of the best experts on this subject based on the ideXlab platform.

  • Aldosterone Antagonist Therapy and Mortality in Patients With ST-Segment Elevation Myocardial Infarction Without Heart Failure: A Systematic Review and Meta-analysis.
    JAMA internal medicine, 2018
    Co-Authors: Khagendra Dahal, Sharan Sharma, Sampath Singireddy, Paari Dominic, Pratap Reddy, Aditya D Hendrani, George Mina, Kalgi Modi
    Abstract:

    Importance Treatment with Aldosterone Antagonists is recommended and has been shown to have beneficial effects in patients with ST-segment elevation myocardial infarction (STEMI) and left ventricular ejection fraction (LVEF) less than 40%. However, the role of Aldosterone Antagonists in patients with ejection fraction greater than 40% or without congestive heart failure is not well known. Objectives To perform a systematic review and meta-analysis using standard techniques to determine the role of therapy with Aldosterone Antagonists in this patient population. Data Sources PubMed, Embase, CINAHL, and Cochrane Central databases were searched and a manual search for relevant references from the selected articles and published reviews was performed from database inception through June 2017. Study Selection Randomized clinical trials that evaluated treatment with Aldosterone Antagonists in patients with STEMI without clinical heart failure or LVEF greater than 40% were included. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used to conduct and report the meta-analysis, which used a random-effects model. Two investigators independently performed the database search and agreed on the final study selection. A manual search was performed for relevant references from the selected articles and published reviews. Main Outcomes and Measures The outcomes analyzed were mortality, new congestive heart failure, recurrent myocardial infarction, ventricular arrhythmia, and changes in LVEF, serum potassium level, and creatinine level at follow-up. Results In all, 10 randomized clinical trials with a total of 4147 unique patients were included in the meta-analysis. In patients who presented with STEMI without heart failure, treatment with Aldosterone Antagonists compared with control was associated with lower risk of mortality (2.4% vs 3.9%; odds ratio [OR], 0.62; 95% CI, 0.42-0.91; P  = .01) and similar risks of myocardial infarction (1.6% vs 1.5%; OR, 1.03; 95% CI, 0.57-1.86; P  = .91), new congestive heart failure (4.3% vs 5.4%; OR, 0.82; 95% CI, 0.56-1.20; P  = .31), and ventricular arrhythmia (4.1% vs 5.1%; OR, 0.76; 95% CI, 0.45-1.31; P  = .33). Similarly, treatment with Aldosterone Antagonists compared with control was associated with a small yet significant increase in LVEF (mean difference, 1.58%; 95% CI, 0.18%-2.97%; P  = .03), a small increase in serum potassium level (mean difference, 0.07 mEq/L; 95% CI, 0.01-0.13 mEq/L; P  = .02), and no change in serum creatinine level (standardized mean difference, 1.4; 95% CI, −0.43 to 3.24; P  = .13). Conclusions and Relevance Treatment with Aldosterone Antagonists is associated with a mortality benefit in patients with STEMI with LVEF greater than 40% or without heart failure.

  • Abstract 19185: Do Aldosterone Antagonists Have Beneficial Effects in Patients With STEMI Without Heart Failure?
    Circulation, 2017
    Co-Authors: Khagendra Dahal, Sharan Sharma, Sampath Singireddy, Paari Dominic, Pratap Reddy, Kalgi Modi
    Abstract:

    Introduction: Aldosterone Antagonists (AA) are recommended and have been shown to have beneficial effects in patients with ST elevation myocardial infarction (STEMI) and left ventricular ejection f...

  • the effects of Aldosterone Antagonists in patients with resistant hypertension a meta analysis of randomized and nonrandomized studies
    American Journal of Hypertension, 2015
    Co-Authors: Khagendra Dahal, Sumit Kunwar, Jharendra Rijal, Fahad Alqatahni, Raju Panta, Noshi Ishak, Roy Patterson Russell
    Abstract:

    Abstract A few studies have shown Aldosterone Antagonists (AA) to be effective therapy in patients with resistant hypertension (RH). We performed a meta-analysis of randomized and nonrandomized studies of AA in patients with RH. We searched PUBMED, EMBASE, and CENTRAL for studies on the use of AA in patients with RH. Meta-analysis was performed using random-effects model. The change in office and ambulatory blood pressures (BP), effects on biochemical profile, change in the number of antihypertensive agents, and adverse events were main outcomes. We included 15 studies (3 randomized controlled trials, 1 nonrandomized comparative study, and 11 single-arm studies) with 1,204 total patients in the meta-analysis. In comparative studies, AA reduced systolic BP (SBP) by 24.26mm Hg (95% CI: 8.65-39.87, P = 0.002) and diastolic BP (DBP) by 7.79mm Hg (3.79-11.79, P = 0.0001). Similarly, AA reduced SBP by 22.74mm Hg (18.21-27.27, P

  • the effects of Aldosterone Antagonists in patients with resistant hypertension a meta analysis of randomized and nonrandomized studies
    American Journal of Hypertension, 2015
    Co-Authors: Khagendra Dahal, Sumit Kunwar, Jharendra Rijal, Fahad Alqatahni, Raju Panta, Noshi Ishak, Roy Patterson Russell
    Abstract:

    BACKGROUND A few studies have shown Aldosterone Antagonists (AA) to be effective therapy in patients with resistant hypertension (RH). We performed a meta-analysis of randomized and nonrandomized studies of AA in patients with RH. METHODS We searched PUBMED, EMBASE, and CENTRAL for studies on the use of AA in patients with RH. Meta-analysis was performed using random-effects model. The change in office and ambulatory blood pressures (BP), effects on biochemical profile, change in the number of antihypertensive agents, and adverse events were main outcomes. RESULTS We included 15 studies (3 randomized controlled trials, 1 nonrandomized comparative study, and 11 single-arm studies) with 1,204 total patients in the meta-analysis. In comparative studies, AA reduced systolic BP (SBP) by 24.26 mm Hg (95% CI: 8.65-39.87, P = 0.002) and diastolic BP (DBP) by 7.79 mm Hg (3.79-11.79, P = 0.0001). Similarly, AA reduced SBP by 22.74 mm Hg (18.21-27.27, P < 0.00001) and DBP by 10.49 mm Hg (8.85-12.13, P < 0.00001) in single-arm studies. AA resulted in significant change in serum electrolytes in single-arm studies but not in comparative studies. Significantly more adverse events were noted in single-arm studies but not in comparative studies. CONCLUSIONS On the basis of the current meta-analysis, we conclude that AA is safe and effective therapy in patients with RH.