Treatment of Heart Failure With Aldosterone Antagonist Therapy.
This article discusses the clinical trial data for the treatment of heart failure with a reduced left
ventricular ejection fraction with an aldosterone antagonist. The American College of
Cardiology/American Heart Association heart failure guidelines recommend with
a class I indication the addition of an aldosterone antagonist in selected patients with New York
Heart Association class II to IV HFrEF who can be carefully monitored for preserved
renal function and normal serum potassium concentration.
Patients treated with an aldosterone antagonist should have a serum creatinine 2.5 mg/dL or lower in men and 2.0 mg/dL or lower in women, and the serum potassium should be less than 5.0 mEq/L. This article also discusses the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist trial which randomized 3,445 patients with symptomatic heart failure with preserved
ejection fraction to receive either spironolactone 15 mg to 45 mg daily or placebo. Of these patients, 51% were from the Americas, and 49% were from Russia and Georgia.
In the Americas group, compared with placebo, spironolactone decreased the primary outcome 18%, decreased cardiovascular mortality 26%, decreased hospitalization for heart failure 18%,
decreased recurrent heart failure 25%, insignificantly decreased all-cause mortality 17%, had
a 60% increased incidence of doubling of serum creatinine, had a similar incidence of serum
creatinine ≥3.0 mg/dL, increased hyperkalemia 3.46 times, and reduced hyokalemia 49%. In
the Russia and Georgia group, all of these outcomes were similar for patients treated with spironolactone or placebo.
Heart Res Open J. 2016; SE(1): S16-S20. doi: 10.17140/HROJ-SE-1-103