Back to Browse Journals » Vascular Health and Risk Management » Volume 7

Aldosterone and aldosterone receptor antagonists in patients with chronic heart failure

Authors Nappi J, Sieg A

Published 8 June 2011 Volume 2011:7 Pages 353—363

DOI https://doi.org/10.2147/VHRM.S13779

Review by Single-blind

Peer reviewer comments 3

Jean M Nappi, Adam Sieg
Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Medical University of South Carolina Campus, Charleston, SC, USA

Abstract: Aldosterone is a mineralocorticoid hormone synthesized by the adrenal glands that has several regulatory functions to help the body maintain normal volume status and electrolyte balance. Studies have shown significantly higher levels of aldosterone secretion in patients with congestive heart failure compared with normal patients. Elevated levels of aldosterone have been shown to elevate blood pressure, cause left ventricular hypertrophy, and promote cardiac fibrosis. An appreciation of the true role of aldosterone in patients with chronic heart failure did not become apparent until the publication of the Randomized Aldactone Evaluation Study. Until recently, the use of aldosterone receptor antagonists has been limited to patients with severe heart failure and patients with heart failure following myocardial infarction. The Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF) study added additional evidence to support the expanded use of aldosterone receptor antagonists in heart failure patients. The results of the EMPHASIS-HF trial showed that patients with mild-to-moderate (New York Heart Association Class II) heart failure had reductions in mortality and hospitalizations from the addition of eplerenone to optimal medical therapy. Evidence remains elusive about the exact mechanism by which aldosterone receptor antagonists improve heart failure morbidity and mortality. The benefits of aldosterone receptor antagonist use in heart failure must be weighed against the potential risk of complications, ie, hyperkalemia and, in the case of spironolactone, possible endocrine abnormalities, in particular gynecomastia. With appropriate monitoring, these risks can be minimized. We now have evidence that patients with mild-to-severe symptoms associated with systolic heart failure will benefit from the addition of an aldosterone receptor antagonist to the standard therapies of angiotensin-converting enzyme inhibitors and beta-blockers. This review will address the pharmacologic basis of aldosterone receptor antagonists in patients with heart failure and the clinical impact of this therapy.

Keywords: aldosterone receptor antagonists, eplerenone, spironolactone, systolic heart failure

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]

 

Readers of this article also read:

Validation of four automatic devices for self-measurement of blood pressure according to the international protocol of the European Society of Hypertension

Topouchian J, Agnoletti D, Blacher J, Youssef A, Ibanez I, Khabouth J, Khawaja S, Beaino L, Asmar R

Vascular Health and Risk Management 2011, 7:709-717

Published Date: 30 November 2011

Prevalence of significant carotid artery stenosis in Iranian patients with peripheral arterial disease

Bavil AS, Ghabili K, Daneshmand SE, Nemati M, Bavil MS, Namdar H, Shaafi S

Vascular Health and Risk Management 2011, 7:629-632

Published Date: 11 October 2011

Troponin elevation in conditions other than acute coronary syndromes

Tanindi A, Cemri M

Vascular Health and Risk Management 2011, 7:597-603

Published Date: 22 September 2011

Lipid-lowering therapy: who can benefit

Lewis SJ

Vascular Health and Risk Management 2011, 7:525-534

Published Date: 24 August 2011

Oral antiplatelet therapy in diabetes mellitus and the role of prasugrel: an overview

Hillegass WB, Brott BC, Dobbs JC, Papapietro SE, Misra VK, Zoghbi GJ

Vascular Health and Risk Management 2011, 7:445-459

Published Date: 18 July 2011

Stentless aortic valve replacement: an update

Kobayashi J

Vascular Health and Risk Management 2011, 7:345-351

Published Date: 2 June 2011

Cardiovascular risk evaluation and prevalence of silent myocardial ischemia in subjects with asymptomatic carotid artery disease

Marco Matteo Ciccone, Asabella Artor Niccoli, Pietro Scicchitano, et al

Vascular Health and Risk Management 2011, 7:129-134

Published Date: 4 March 2011

ACE up the sleeve – are vascular patients medically optimized

AP Coveney, GC O'Brien, GJ Fulton

Vascular Health and Risk Management 2011, 7:15-21

Published Date: 7 January 2011