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Spironolactone has been marketed for over half a century as a 'potassium-sparing diuretic', used primarily in patients with ascites. With the realization that primary aldosteronism is the most common (5-13%) form of secondary hypertension, it has become widely used as a mineralocorticoid receptor antagonist. More recently, in the wake of the RALES trial, spironolactone in addition to standard therapy has been shown to be very beneficial in heart failure with a reduced ejection fraction. Despite the failure of the TOPCAT trial, spironolactone is being increasingly used in diastolic heart failure (i.e. with a preserved ejection fraction). The third currently accepted role for spironolactone is in hypertension resistant to three conventional antihypertensives including a diuretic, where it has been proven to be effective, in contra-distinction to renal artery denervation. Finally, brief consideration will be given to 'areas in waiting' - pulmonary hypertension/fibrosis, cancer - where spironolactone may play very useful roles.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5615771 | PMC |
| http://dx.doi.org/10.12688/f1000research.11887.1 | DOI Listing |
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Article Synopsis
- Activation of the renin-angiotensin-aldosterone system is crucial in heart failure, where excess aldosterone causes various cardiovascular issues like vascular stiffness and inflammation.
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- Ongoing research is exploring newer-generation mineralocorticoid antagonists and aldosterone synthase inhibitors, particularly their effects on patients with heart failure and preserved ejection fraction.
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