Mineralocorticoid receptor antagonists for heart failure with reduced ejection fraction: integrating evidence into clinical practice.

Published

Journal Article (Review)

Mineralocorticoid receptor antagonists (MRAs) improve survival and reduce morbidity in patients with heart failure, reduced ejection fraction (HF-REF), and mild-to-severe symptoms, and in patients with left ventricular systolic dysfunction and heart failure after acute myocardial infarction. These clinical benefits are observed in addition to those of angiotensin converting enzyme inhibitors or angiotensin receptor blockers and beta-blockers. The morbidity and mortality benefits of MRAs may be mediated by several proposed actions, including antifibrotic mechanisms that slow heart failure progression, prevent or reverse cardiac remodelling, or reduce arrhythmogenesis. Both eplerenone and spironolactone have demonstrated survival benefits in individual clinical trials. Pharmacologic differences exist between the drugs, which may be relevant for therapeutic decision making in individual patients. Although serious hyperkalaemia events were reported in the major MRA clinical trials, these risks can be mitigated through appropriate patient selection, dose selection, patient education, monitoring, and follow-up. When used appropriately, MRAs significantly improve outcomes across the spectrum of patients with HF-REF.

Full Text

Duke Authors

Cited Authors

  • Zannad, F; Gattis Stough, W; Rossignol, P; Bauersachs, J; McMurray, JJV; Swedberg, K; Struthers, AD; Voors, AA; Ruilope, LM; Bakris, GL; O'Connor, CM; Gheorghiade, M; Mentz, RJ; Cohen-Solal, A; Maggioni, AP; Beygui, F; Filippatos, GS; Massy, ZA; Pathak, A; Piña, IL; Sabbah, HN; Sica, DA; Tavazzi, L; Pitt, B

Published Date

  • November 2012

Published In

Volume / Issue

  • 33 / 22

Start / End Page

  • 2782 - 2795

PubMed ID

  • 22942339

Pubmed Central ID

  • 22942339

Electronic International Standard Serial Number (EISSN)

  • 1522-9645

International Standard Serial Number (ISSN)

  • 0195-668X

Digital Object Identifier (DOI)

  • 10.1093/eurheartj/ehs257

Language

  • eng