Mineralocorticoid receptor antagonists in the management of heart failure and resistant hypertension

A review

David M. Flatt, Michael C. Brown, Adam M. Mizeracki, Bryan J. King, Karl Weber

Research output: Contribution to journalReview article

7 Citations (Scopus)

Abstract

IMPORTANCE Heart failure (HF), with or without reduced ejection fraction, and multidrug-resistant hypertension (RHT) are major worldwide health problems of ever-increasing proportions. The mineralocorticoid receptor antagonists (MRAs) spironolactone and eplerenone have proved valuable additions to the overall management of these disorders in patients without significant renal dysfunction. OBSERVATIONS Neurohormonal activation, including aldosteronism, in HF and RHT, has provided the pathophysiologic basis for the inclusion of MRA in the overall management of these disorders and the respective survival benefit and control of blood pressure. Furthermore, MRAs attenuate the appearance of secondary hyperparathyroidism that accompanies excretory Ca2+ losses induced by aldosteronism in which elevated parathyroid hormone levels raise the risk of adverse cardiovascular events and atraumatic bone fracture. Serial surveillance of serum electrolytes and creatinine levels is mandated to avoid serious hyperkalemia (potassium concentration >5.5 mEq/L) and its attendant risks in patients receiving MRAs. CONCLUSIONS AND RELEVANCE Mineralocorticoid receptor antagonists are a valuable addition to the practice of medicine. Their judicious use in patients with HF or RHT can improve treatment of these patients.

Original languageEnglish (US)
Pages (from-to)607-612
Number of pages6
JournalJAMA Cardiology
Volume1
Issue number5
DOIs
StatePublished - Aug 1 2016

Fingerprint

Mineralocorticoid Receptor Antagonists
Heart Failure
Hypertension
Hyperaldosteronism
Spironolactone
Hyperkalemia
Secondary Hyperparathyroidism
Bone Fractures
Parathyroid Hormone
Electrolytes
Creatinine
Potassium
Medicine
Blood Pressure
Kidney
Survival
Serum

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Mineralocorticoid receptor antagonists in the management of heart failure and resistant hypertension : A review. / Flatt, David M.; Brown, Michael C.; Mizeracki, Adam M.; King, Bryan J.; Weber, Karl.

In: JAMA Cardiology, Vol. 1, No. 5, 01.08.2016, p. 607-612.

Research output: Contribution to journalReview article

Flatt, David M. ; Brown, Michael C. ; Mizeracki, Adam M. ; King, Bryan J. ; Weber, Karl. / Mineralocorticoid receptor antagonists in the management of heart failure and resistant hypertension : A review. In: JAMA Cardiology. 2016 ; Vol. 1, No. 5. pp. 607-612.
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