Dapagliflozin-spironolactone combo improves outcomes in HFpEF patients

Combined treatment with dapagliflozin and spironolactone results in greater reductions in N-terminal pro–B-type natriuretic peptide (NT-proBNP) than dapagliflozine alone in patients with heart failure with preserved ejection fraction (HFpEF), a recent study has shown. 

The combination therapy also leads to greater estimated glomerular filtration rate (eGFR) decrease and potassium increase. 

A total of 108 patients (median age 76 years, 57 percent women, eGFR 72 mL/min/1.73 m2, potassium 4.3 mmol/L) were randomized to receive either dapagliflozin plus spironolactone or dapagliflozin alone. Nearly half (45 percent) of the participants had diabetes. Each treatment was given for 12 weeks. 

The median NT-proBNP was 746 pg/mL, while the median LogNT-proBNP was 6.6 Log-units. The combined therapy reduced LogNT-proBNP levels by –0.11 Log units (95 percent confidence interval [CI], –0.22 to –0.01; p=0.035) compared with dapagliflozin alone. This corresponded to an 11-percent relative decrease and increased the odds of reaching ≥20-percent NT-proBNP reduction (odds ratio [OR], 2.27, 95 percent CI, 1.16–4.44; p=0.016). 

Additionally, treatment with dapagliflozine plus spironolactor also reduced systolic blood pressure (–5.2 mm Hg, 95 percent CI, –8.4 to –2.0), Logurinary-albumin-to-creatinine ratio (–0.32 Log, 95 percent CI, –0.54 to –0.11), eGFR (–6.4 mL/min/1.73 m2, 95 percent CI, –8.3 to –4.4), and increased serum potassium (0.32 mmol/L, 95 percent CI, 0.23–0.41) and the frequency of serum potassium (>5.5 mmol/L: 4.8 percent vs 0.9 percent) compared with dapagliflozin alone.