Jan 13, 2015

Evolving role for mineralocorticoid receptor antagonists in heart failure with preserved ejection fraction

Current Opinion in Cardiology
Robert J H Miller, Jonathan G Howlett

Abstract

The majority of randomized clinical trials in heart failure with preserved ejection fraction (HFpEF) have failed to show meaningful improvements in clinical outcomes. Recent randomized trials have shown benefits from mineralocorticoid receptor antagonists (MRAs) in the management of HFpEF. This review will focus on new evidence for MRA therapy in patients with HFpEF. Three randomized trials were reviewed: the Effect of spironolactone on diastolic function and exercise capacity in patients with heart failure with preserved ejection fraction: the Aldo-DHF randomized controlled trial; the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial; and its echocardiography substudy. The Aldo-DHF trial showed improvements in echocardiographic measures of diastolic function. In the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist trial, hospitalization for heart failure was significantly reduced with MRA therapy with no difference in the primary outcome of cardiovascular death or hospitalization. In patients with high risk, however, there may be a reduction in cardiovascular mortality. We will also briefly discuss finerenone, a new generation MRA associated with a lo...Continue Reading

Mentioned in this Paper

Mineralocorticoid Receptor Antagonists [MoA]
Randomized Controlled Trial (Publication)
Clinical Trials, Randomized
Spironolactone
Aldosterone Antagonist [EPC]
Mineralocorticoid Receptor Antagonists
Echocardiography
MRAS gene
Biologic Preservation
Aldosterone Antagonists [MoA]

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