{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T00:07:31Z","timestamp":1792886851424,"version":"4.5.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"23","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Resistant hypertension is a salt\u2010retaining condition possibly attributable to inappropriate aldosterone secretion.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              This study was a secondary analysis of the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial. Patients with heart failure with preserved ejection fraction (HFpEF) with (n=1004) and without (n=2437) resistant hypertension were included. Resistant hypertension was defined as systolic blood pressure \u2265130\u00a0mm\u00a0Hg and\/or diastolic blood pressure \u226580\u00a0mm\u00a0Hg in a patient with hypertension, despite the concurrent use of a renin\u2010angiotensin system blocker (angiotensin\u2010converting enzyme inhibitor\/angiotensin receptor blocker), a calcium channel blocker, and a diuretic; or as those patients using \u22654 classes of antihypertensive medication. The primary outcome was a composite of cardiovascular death, aborted cardiac arrest, or heart failure hospitalization. We analyzed hazard ratios (HRs) for outcomes with 95% CIs in the spironolactone group and compared them with the placebo group using Cox proportional hazard models. The risk of primary outcome events in patients with HFpEF with resistant hypertension was significantly lower in the spironolactone group than in the placebo group (HR, 0.70; 95% CI, 0.53\u20130.91;\n              <jats:italic>P<\/jats:italic>\n              =0.009), whereas the risk of primary outcome events in patients with HFpEF without resistant hypertension was not significantly different between the 2 groups (HR, 1.00; 95% CI, 0.83\u20131.20;\n              <jats:italic>P<\/jats:italic>\n              =0.97). There was a significant interaction between spironolactone use and resistant hypertension (\n              <jats:italic>P<\/jats:italic>\n              =0.03). Similar associations were also observed in patients with HFpEF from the Americas (United States, Canada, Brazil, and Argentina) only.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Spironolactone may be an effective add\u2010on medication for patients with HFpEF with resistant hypertension taking angiotensin\u2010converting enzyme inhibitors\/angiotensin receptor blockers, calcium channel blockers, and diuretics.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.018827","type":"journal-article","created":{"date-parts":[[2020,11,23]],"date-time":"2020-11-23T10:55:25Z","timestamp":1606128925000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":45,"title":["Spironolactone Use and Improved Outcomes in Patients With Heart Failure With Preserved Ejection Fraction With Resistant Hypertension"],"prefix":"10.1161","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0230-1718","authenticated-orcid":false,"given":"Tetsuro","family":"Tsujimoto","sequence":"first","affiliation":[{"name":"Department of Diabetes, Endocrinology, and Metabolism Center Hospital National Center for Global Health and Medicine Tokyo Japan"},{"name":"Department of Diabetes and Endocrinology Toranomon Hospital Kajigaya Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Kajio","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Endocrinology, and Metabolism Center Hospital National Center for Global Health and Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa052256"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw128"},{"key":"e_1_3_2_4_2","first-page":"e240","article-title":"2013 ACCF\/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on practice guidelines","author":"Writing Committee Members","year":"2013","unstructured":"Writing Committee Members , Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, et al. 2013 ACCF\/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on practice guidelines. Circulation. 2013;e240\u2013e327.","journal-title":"Circulation"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.04.025"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/HCO.0000000000000292"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.112.972794"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.097345"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00257-3"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(18)30071-8"},{"key":"e_1_3_2_11_2","unstructured":"Biologic Specimen and Data Repositories Information Coordinating Center. National Heart Lung and Blood Institute. https:\/\/biolincc.nhlbi.nih.gov\/studies\/topcat\/. 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Hypertension. 2018;e53\u2013e90.","journal-title":"Hypertension"},{"key":"e_1_3_2_15_2","first-page":"e116","article-title":"Systematic review for the 2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","author":"Reboussin DM","year":"2018","unstructured":"Reboussin DM, Allen NB, Griswold ME, Guallar E, Hong Y, Lackland DT, Miller EPR III, Polonsky T, Thompson\u2010Paul AM, Vupputuri S. Systematic review for the 2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;e116\u2013e135.","journal-title":"Hypertension"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYP.0000000000000066"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy339"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.013255"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.114.03850"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.112.197780"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199909023411001"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.118.12156"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajh\/hpx210"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040135"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.120.018827","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:04:43Z","timestamp":1715598283000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.120.018827"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12]]},"references-count":23,"journal-issue":{"issue":"23","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1161\/JAHA.120.018827"],"URL":"https:\/\/doi.org\/10.1161\/jaha.120.018827","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12]]},"assertion":[{"value":"2020-08-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e018827"}}