Mineralocorticoid Receptor Antagonist Therapy in Heart Failure Management
Summary
Mineralocorticoid receptor antagonists (MRAs) represent a cornerstone of pharmacological management in heart failure, particularly in patients with reduced left ventricular ejection fraction. By blocking the deleterious effects of aldosterone—namely sodium retention, myocardial fibrosis and adverse remodelling—agents such as spironolactone, eplerenone and newer nonsteroidal compounds have been shown to reduce hospitalisation and mortality. Seminal trials established the efficacy of MRAs in chronic heart failure, leading to guideline recommendations for their use in patients with symptomatic class II–IV disease or following acute myocardial infarction with systolic dysfunction. Despite robust evidence, real-world uptake remains suboptimal, reflecting concerns over hyperkalaemia, renal function deterioration and monitoring burdens. Recent practice has focused on integrating MRAs with other life-prolonging therapies, including renin–angiotensin–aldosterone system inhibitors, angiotensin receptor-neprilysin inhibitors and sodium–glucose cotransporter 2 inhibitors, to optimise neurohormonal blockade. Ongoing research seeks to refine patient selection, dosing strategies and safety monitoring, ensuring global applicability and improving outcomes across diverse healthcare settings.
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Mineralocorticoid Receptor Antagonist Therapy in Heart Failure Management publication trend
The graph below shows the total number of articles in mineralocorticoid receptor antagonist therapy in heart failure management across all publications each year (not limited to Nature Index journals).
Technical terms
Mineralocorticoid receptor antagonist: A drug blocking aldosterone action to reduce sodium retention and myocardial fibrosis.
Ejection fraction: Percentage of blood ejected from the left ventricle with each contraction.
Heart failure with reduced ejection fraction (HFrEF): Cardiac dysfunction characterised by an ejection fraction below 40%.
Hyperkalaemia: Elevated serum potassium concentration that can precipitate arrhythmias.
Left ventricular remodelling: Structural changes in the left ventricle after injury or chronic stress, including dilation and fibrosis.
References
- Barriers to Adoption of Mineralocorticoid Receptor Antagonists in Patients With Heart Failure: A Mixed‐Methods Study. Journal of the American Heart Association (2016).
- Dapagliflozin in patients with heart failure with mildly reduced and preserved ejection fraction treated with a mineralocorticoid receptor antagonist or sacubitril/valsartan. European Journal of Heart Failure (2022).
- Aldosterone Blockade in Acute Myocardial Infarction: A Systematic Review and Meta‐Analysis. Cardiovascular Therapeutics (2021).
- Spironolactone Improves the All-Cause Mortality and Re-Hospitalization Rates in Acute Myocardial Infarction with Chronic Kidney Disease Patients. Frontiers in Pharmacology (2021).
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