Dr. Erika Kancler
Objective: To assess the efficacy of improving diastolic dysfunction with the use of nebivolol, a selective beta-1 adrenergic receptor antagonist, as compared to spironolactone, a mineralocorticoid receptor antagonist, in the treatment of diastolic heart failure. To assess whether or not these medications have a favorable outcome in terms of improving exercise capacity in patients with Heart Failure with Preserved Ejection Fraction (HFpEF). Design: Systematic Literature Review. Methods: Searches in PubMed and the JMU online library database using mesh terms that included “diastolic heart failure”, “nebivolol”, and “spironolactone”. In order to narrow down relevant articles, filter terms included “humans”, “published in the last 5 years”, “full text” and “English.” This literature review includes three separate studies pertaining to different treatment modalities for diastolic heart failure. We focused on the use of nebivolol as compared to spironolactone as mainstay therapies in the treatment regimen for heart failure with a preserved ejection fraction. The Aldo-DHF randomized control trial was included for its research in assessing the efficacy of improving diastolic function and maximizing exercise capacity in patients with HFpEF. The study with a focus on treatment with spironolactone in elderly women with HFpEF was included because it focused on baseline and endpoint data concerning improvement in exercise capacity as well as left ventricular (LV) structure and function on echocardiogram and biomarkers such as brain natriuretic peptide (BNP). The ELANDD study was included because it discussed mechanisms of nitric oxide release and subsequent peripheral vasodilation, which was hypothesized to improve aortic and ventricular compliance and thus improve diastolic filling. Results – spironolactone was found to improve left ventricular diastolic function, but had no effect on maximal exercise capacity and did not improve patient symptoms or quality of life. Spironolactone was also shown to have beneficial effects on the remodeling of the ventricle. The selective beta-1 adrenergic receptor antagonist, nebivolol, was found to have no improvement in maximal exercise capacity and was found to have a neutral effect on both peak oxygen uptake during exercise and pro brain natriuretic peptide plasma levels (pro-BNP). Nebivolol did decrease resting and peak blood pressure and heart rate as compared to the placebo.
Fenter AT, Joseph CE. Comparing Nebivolol and Spironolactone in the Treatment of Heart Failure with a Preserved Ejection Fraction. JMU Scholarly Commons Physician Assistant Capstones. http://commons.lib.jmu.edu/pacapstones/19. Published May 16, 2017.