A recent randomized crossover trial evaluated the efficacy and safety of combining dapagliflozin with spironolactone versus using dapagliflozin alone in patients with heart failure with mildly reduced or preserved ejection fraction. Involving 108 participants (median age 76, 57% women), estimated glomerular filtration rate (eGFR) 72 mL/min/1.73 m2，the 12-week study found that the combination therapy led to a greater reduction in NT-proBNP levels and doubled the odds of achieving at least a 20% NT-proBNP reduction (OR = 2.27) compared to dapagliflozin alone. Additional benefits of the combination included lower systolic blood pressure and reduced urinary albumin-to-creatinine ratio. However, it also resulted in a greater decline in kidney function (−6.4 mL/min/1.73 m² in eGFR) and increased serum potassium levels, with more cases of hyperkalemia observed. These findings suggest that while dapagliflozin/spironolactone may offer added benefit in lowering NT-proBNP, it comes with increased risk for kidney function decline and elevated potassium, warranting careful monitoring in clinical use. Source: https://www.jacc.org/
