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    Diuretic Pill Cuts Deaths in Heart Failure Patients

    Inspra, Already Used to Treat Advanced Heart Failure, Found Effective in People With Mild Disease

    Inspra's Cheaper Cousin May Offer Option in Heart Failure continued...

    "A reasonable tactic" would be to try the older drug first and reserve the more expensive one for the few patients for whom spironolactone's side effects are disabling, he writes.

    Clyde Yancy, MD, of Baylor University Medical Center in Dallas and immediate past president of the AHA, says that some patients may prefer Inspra because it doesn't cause breast enlargement in men and loss of libido in women. Spironolactone causes these side effects in about 10% of patients, he tells WebMD.

    As the AHA prepares to revise its guidelines for heart failure in 2011, the new findings will be given "strong consideration," says Yancy, who heads the guidelines committee.

    Currently, only about one-third of people with advanced heart failure who are candidates for Inspra or spironolactone get the drugs, he notes.

    "Hopefully these findings will push more doctors to use them" in people with mild and advanced disease, unless there is a medical reason not to, Yancy says.

    Potassium Levels Need to Be Monitored

    The trial involved 2,737 patients 55 or older with mild heart failure. They were given either Inspra or placebo.

    Participants continued to take their standard medications, which typically included an ACE inhibitor, an angiotensin receptor blocker (ARB), or both, and a beta-blocker.

    The study was stopped early because of Inspra's overwhelming benefits. Side effects were slightly less common in the Inspra group: 13.8% vs. 16.2% for placebo, but the difference could have been due to chance.

    Because of the way the drug works in the body, it increased the number of people with dangerously high potassium blood levels, Yancy says.

    If you are on Inspra, your blood potassium levels need to be monitored carefully and the dose adjusted as needed, he says.

    Armstrong says that although the patients had mild disease, they were at fairly high risk of complications. This may limit generalizing the findings to all patients with mild disease, he says.

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