The aim of this study was to evaluate the effects of low dose aldosterone antagonist alone or in combination with angiotensin converting enzyme (ACE) inhibitors on the progression of left ventricular dysfunction and remodeling in a congenic rat model of hypertrophic cardiomyopathy. Congenic SS-16BN/Mcwi rats were produced by transfer of chromosome 16 from the BN rat into the salt-sensitive hypertensive (SS/Mcwi) genetic background. The SS-16BN/Mcwi rats developed severe cardiac hypertrophy despite being normotensive even on high salt diet. SS-16BN/Mcwi and SS/Mcwi rats were fed a low salt (0.4% NaCl) diet and treated with either vehicle (CON), spironolactone (20mg/kg per d s.c), captopril (100 mg/kg per d drinking water), or both for four weeks. Echocardiography was performed weekly. Plasma peptide measurements, blood pressure, cardiac fibrosis and heart weight were evaluated at the end of the experimental period. Spironolactone at a low dose had no affect on blood pressure, cardiac fibrosis, heart/body weight ratio and left ventricular wall thickness in either strain. Spironolactone in combination with captopril, decreased the cardiac hypertrophy more than captopril alone. In the SS-16BN/Mcwi rats the combined therapy significantly preserved the cardiac index when compared to control. The study suggests that the addition of low-dose spironolactone to ACE inhibitor treatment prevents the progression of heart hypertrophy independently of blood pressure effects and that combined spironolactone and captopril therapy may be useful in the treatment of hypertrophic cardiomyopathy (Support NIH HL29587, U01 HL66579).