Heart failure & cardiomyopathiesRandomised controlled trial
Sodium-Glucose Cotransporter 2 Inhibitor With and Without an Aldosterone Antagonist for Heart Failure With Preserved Ejection Fraction
- Randomised crossover trial
- prospective
- open
- blinded endpoint
Authors' conclusion
Dapagliflozin/spironolactone combination reduced NT-proBNP more than dapagliflozin. A greater eGFR decline and potassium increase was observed with dapagliflozin/spironolactone combination
Study context
- Population
- HF with mildly reduced or preserved EFrandomised
- Participants
- 108 participants
- Comparison
- Dapagliflozin/spironolactone vs dapagliflozin alone
- Primary endpoint
- LogNT-proBNP difference between dapagliflozin/spironolactone combination and dapagliflozin alone sequences
- Follow-up
- 12 weeks per treatment sequence
Primary result
LogNT-proBNP
Difference
−0.11 Log-units
95% CI −0.22 to −0.01
P = 0.035
Dapagliflozin/spironolactone vs Dapagliflozin
difference −0.11 Log-units (95% CI −0.22 to −0.01); P = 0.035
As reported in the abstract
Further findings
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| ≥20% NT-proBNP reduction | 2.27 (1.16–4.44) | P = 0.016 | |
| 0.20.5125Odds ratio (log scale) |
| Outcome | difference (mm Hg) (95% CI) | P value | |
|---|---|---|---|
| SBP | −5.2 (−8.4 to −2.0) | ||
| −10−505Difference, mm Hg (linear scale) |
| Outcome | difference (Log) (95% CI) | P value | |
|---|---|---|---|
| Log urinary albumin-to-creatinine ratio | −0.32 (−0.54 to −0.11) | ||
| −1−0.500.5Difference, Log (linear scale) |
Safety
| Outcome | difference (mL/min/1.73 m²) (95% CI) | |
|---|---|---|
| eGFR · decrease | −6.4 (−8.3 to −4.4) | |
| −10−505Difference, mL/min/1.73 m² (linear scale) |
Serum potassium >5.5 mmol/L
| Outcome | difference (mmol/L) (95% CI) |
|---|---|
| Serum potassium | +0.32 (0.23–0.41) |
Original publication
Sodium-Glucose Cotransporter 2 Inhibitor With and Without an Aldosterone Antagonist for Heart Failure With Preserved Ejection Fraction. J Am Coll Cardiol. Published 5 August 2025. doi:10.1016/j.jacc.2025.05.033
Summarised from the published abstract; every number is checked against it