Aldosterone antagonists in chronic heart failure treatment

Česká verzia

Authors: P. Gavornik; Ľ. Gašpar; A. Kunová; I. Gašparová; J. Hodulíková
Authors place of work: II. interná klinika Lekárskej fakulty UK a UN Bratislava, Prvé angiologické pracovisko (PAP) Bratislava, Slovenská republika, prednosta doc. MUDr. Ľudovít Gašpar, CSc.
Published in the journal: Vnitř Lék 2012; 58(7 a 8): 23-28
Category: 80. narozeniny prof. MUDr. Miroslava Mydlíka, DrSc.

Summary

The article provides a review of actual information about the place of aldosterone antagonists in the treatment of chronic heart failure. Arterial hypertension and coronary artery disease are among risk factors/diseases of heart failure. Aldosterone antagonists play an important role in the treatment of NYHA class III and IV chronic heart failure, as shown by the RALES (Randomized Aldactone Evaluation Study) trial in the case of spironolactone. Recent trials have shown spironolactone to significantly improve left ventricular remodeling and left ventricular diastolic function in NYHA class I and II chronic heart failure. Aldosterone antagonists are also effective in treating patients after acute myocardial infarction and heart failure, as demonstrated by the EPHESUS (Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study) trial for eplerenone. The EMPHASIS-HF mortality trial has documented the efficacy of eplerenone therapy even in a milder stage of chronic heart failure NYHA class II. The effect of eplerenone seems to be a „class“ one as it closely resembles spironolactone action in the more severe forms of heart failure. In clinical practice, it may be appropriate to initiate treatment with spironolactone reserving eplerenone for patients with spironolactone intolerance. This recommendation is due to the different pricing of the two drugs.

Key words:
chronic heart failure – therapy – aldosterone antagonists – spironolactone – eplerenone

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