The use of mineralocorticoid receptor antagonists in the treatment of heart failure: a literature review

Abstract

Mineralocorticoid receptor antagonists (MRAs) have proven to be highly effective therapeutic options in the treatment of patients with heart failure with reduced ejection fraction (HFrEF) based on randomized clinical trials. Current evidence in these patients clearly indicates that MRAs reduce morbidity and mortality in heart failure patients. Results from the three major trials involving HFrEF patients (RALES, EPHESUS, EMPHASIS-HF) have led both spironolactone and eplerenone to become pivotal drugs in the management of HFrEF patients, with class I indications according to ESC and ACC/AHA heart failure guidelines. The anti-remodeling and anti-fibrotic effects of MRAs may extend their clinical utility to a broader cardiovascular patient population, such as asymptomatic HFrEF patients and certain populations of HFpEF patients. Regarding the latter, the TOPCAT trial demonstrated that although the primary endpoint of the trial was negative, spironolactone significantly reduced heart failure-related hospitalizations without a detrimental effect on mortality. Hopefully, results from future prospective studies, which include investigations with the latest third-generation MRAs (finerenone), will expand the clinical indications of this drug class.

Keywords

• heart failure
• mra
• spironolactone
• eplerenone