SGLT2 inhibitor + spironolactone

GDMT-Nanjing First Hospital, Nanjing Medical University-heart failure with preserved ejection fraction refers to a specific Guideline-Directed Medical Therapy (GDMT) regimen utilized as the pharmacological baseline in clinical trials (such as NCT05941000) led by Nanjing First Hospital. This combination therapy consists of a sodium-glucose co-transporter 2 (SGLT2) inhibitor—specifically dapagliflozin or empagliflozin—and the mineralocorticoid receptor antagonist (MRA) spironolactone. SGLT2 inhibitors work by inhibiting the SGLT2 protein in the proximal tubule of the kidney, which prevents glucose and sodium reabsorption, thereby inducing natriuresis and osmotic diuresis to reduce cardiac preload and afterload. Spironolactone acts by competitively antagonizing the mineralocorticoid receptor, preventing the binding of aldosterone, which leads to decreased sodium retention and potassium excretion, and helps mitigate myocardial fibrosis. This regimen is employed in patients with heart failure with preserved ejection fraction (HFpEF) to provide a standardized background therapy for evaluating the additive efficacy of interventional procedures like Pulmonary Artery Denervation (PADN).

Other names

GDMT-Nanjing First Hospital, Nanjing Medical University-heart failure with preserved ejection fractionGDMTGuideline-Directed Medical TherapySGLT2i + MRA