{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:30:53Z","timestamp":1784694653457,"version":"3.55.0"},"reference-count":51,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2017,5,19]],"date-time":"2017-05-19T00:00:00Z","timestamp":1495152000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AG18915"],"award-info":[{"award-number":["R01AG18915"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010512","name":"Claude D. Pepper Older Americans Independence Center, University of California San Francisco","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010512","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007154","name":"Wake Forest University","doi-asserted-by":"publisher","award":["P30AG21332"],"award-info":[{"award-number":["P30AG21332"]}],"id":[{"id":"10.13039\/100007154","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007930","name":"Institute of Clinical and Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007930","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008478","name":"Wake Forest School of Medicine","doi-asserted-by":"publisher","award":["NIH UL1TR001420"],"award-info":[{"award-number":["NIH UL1TR001420"]}],"id":[{"id":"10.13039\/100008478","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008478","name":"Wake Forest School of Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008478","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      To evaluate the effects of an aldosterone antagonist on exercise intolerance in older adults with heart failure and preserved ejection fraction (\n                      <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n                      p\n                      <jats:styled-content style=\"fixed-case\">EF<\/jats:styled-content>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Randomized, placebo\u2010controlled, double\u2010blind trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Academic medical center, Winston\u2010Salem, North Carolina.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      Older adults (N\u00a0=\u00a080, aged 71\u00a0\u00b1\u00a01; 80% female) with stable compensated\n                      <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n                      p\n                      <jats:styled-content style=\"fixed-case\">EF<\/jats:styled-content>\n                      and controlled blood pressure (\n                      <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>\n                      Participants were randomized into a 9\u2010month treatment of spironolactone 25\u00a0mg\/d vs placebo. Assessments were peak exercise oxygen consumption (\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>V<\/jats:italic>\n                        O\n                      <\/jats:styled-content>\n                      <jats:sub>2<\/jats:sub>\n                      ), 6\u2010minute walk test, Minnesota Living with Heart Failure Questionnaire (\n                      <jats:styled-content style=\"fixed-case\">MLHFQ<\/jats:styled-content>\n                      ), cardiac magnetic resonance imaging, Doppler echocardiography, and vascular ultrasound.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy\u2010one participants completed the trial: 37 in the spironolactone group and 34 in the placebo group. Adherence according to pill count was excellent (spironolactone 95%, placebo 97%). Mean spironolactone dose was 24.3\u00a0\u00b1\u00a02.9\u00a0mg\/d and was well tolerated. Spironolactone significantly reduced systolic and diastolic\n                      <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content>\n                      at rest and peak exercise. At 9\u2010month follow\u2010up, baseline\u2010adjusted peak\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>V<\/jats:italic>\n                        O\n                      <\/jats:styled-content>\n                      <jats:sub>2,<\/jats:sub>\n                      the primary outcome, was 13.5\u00a0\u00b1\u00a00.3\u00a0\n                      <jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>\n                      \/kg per minute in the spironolactone group versus 13.9\u00a0\u00b1\u00a00.3\u00a0\n                      <jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>\n                      \/kg per minute in the placebo group (adjusted mean difference\u00a0\u22120.4\u00a0\n                      <jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>\n                      \/kg per minute; 95% confidence interval\u00a0=\u00a0\u22121.1\u20130.4\u00a0\n                      <jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>\n                      \/kg per minute;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.38). The 95% confidence intervals of spironolactone's effect on peak\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>V<\/jats:italic>\n                        O\n                      <\/jats:styled-content>\n                      <jats:sub>2<\/jats:sub>\n                      (\u22128.2% to 3.2%) excluded a clinically significant beneficial effect. There were also no significant differences in 6\u2010minute walk distance, arterial stiffness, left ventricular (\n                      <jats:styled-content style=\"fixed-case\">LV<\/jats:styled-content>\n                      ) mass,\n                      <jats:styled-content style=\"fixed-case\">LV<\/jats:styled-content>\n                      mass\/end\u2010diastolic volume, or\n                      <jats:styled-content style=\"fixed-case\">MLHFQ<\/jats:styled-content>\n                      score.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      In older adults with stable compensated\n                      <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n                      p\n                      <jats:styled-content style=\"fixed-case\">EF<\/jats:styled-content>\n                      , 9 months of spironolactone 25\u00a0mg\/d was well tolerated and reduced\n                      <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content>\n                      but did not improve exercise capacity, quality of life,\n                      <jats:styled-content style=\"fixed-case\">LV<\/jats:styled-content>\n                      mass, or arterial stiffness.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.14940","type":"journal-article","created":{"date-parts":[[2017,5,23]],"date-time":"2017-05-23T11:37:28Z","timestamp":1495539448000},"page":"2374-2382","source":"Crossref","is-referenced-by-count":50,"title":["Effect of Spironolactone on Exercise Tolerance and Arterial Function in Older Adults with Heart Failure with Preserved Ejection Fraction"],"prefix":"10.1111","volume":"65","author":[{"given":"Bharathi","family":"Upadhya","sequence":"first","affiliation":[{"name":"Cardiovascular Medicine Section Department of Internal Medicine School of Medicine Wake Forest University Winston\u2010Salem North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William G.","family":"Hundley","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Section Department of Internal Medicine School of Medicine Wake Forest University Winston\u2010Salem North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter H.","family":"Brubaker","sequence":"additional","affiliation":[{"name":"Department of Health and Exercise Science Wake Forest University Winston\u2010Salem North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy M.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Division of Public Health Sciences School of Medicine Wake Forest University Winston\u2010Salem North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn P.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Section Department of Internal Medicine School of Medicine Wake Forest University Winston\u2010Salem North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalane W.","family":"Kitzman","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Section Department of Internal Medicine School of Medicine Wake Forest University Winston\u2010Salem North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,5,19]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa052256"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.17.2144"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.08.015"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.107.095489"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.31.1.451"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000048892.83521.58"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01447-4"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.2459\/JCM.0000000000000102"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.14.1729"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-7133.2009.00056.x"},{"key":"e_1_2_7_12_1","first-page":"e240","article-title":"2013 ACCR\/AHA Guideline for the Management of Heart Failure","volume":"128","author":"Yancy CW","year":"2013","journal-title":"Circulation"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(98)00502-5"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.109.898916"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.110.958785"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.17346"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(91)90832-T"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(92)90094-4"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199511023331806"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejheart.2004.08.003"},{"key":"e_1_2_7_21_1","first-page":"919","article-title":"The 6\u2010minute walk: A new measure of exercise capacity in patients with chronic heart failure","volume":"132","author":"Guyatt GH","year":"1985","journal-title":"Can Med Assoc J"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2004.09.010"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.34.2.201"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1161\/hc3801.097806"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(91)90542-H"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(93)90582-W"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.2307\/2531543"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199909023411001"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa030207"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009492"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2011.04.007"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.905"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1313731"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.013255"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv464"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31826fb946"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.07.763"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.3109\/10976640009148691"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/gls099"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.109.140988"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2005.02363.x"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.03.066"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01116-0"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.109.903773"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.02.055"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00049.2015"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2014.07.010"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.114.001825"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.03.077"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.109.930701"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000138680.89536.A9"},{"key":"e_1_2_7_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.05.014"}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjgs.14940","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.14940","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T17:49:51Z","timestamp":1762192191000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.14940"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5,19]]},"references-count":51,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2017,11]]}},"alternative-id":["10.1111\/jgs.14940"],"URL":"https:\/\/doi.org\/10.1111\/jgs.14940","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,5,19]]}}}