Aldosterone antagonists in heart failure with reduced ejection fraction

Heart failure with reduced ejection fraction is associated with increased mortality, limited functional capacity and poor quality of life. The renin–angiotensin–aldosterone system (RAAS) is an essential compensatory mechanism that attempts to maintain organ perfusion. The secretion of aldosterone, which increases preload through the prevention of the loss of sodium and water from the kidney, is integral to the RAAS. Aldosterone antagonists inhibit the action of aldosterone, decrease the preload and reduce the workload of a failing left ventricle. Findings from randomized controlled trials demonstrate a mortality benefit in addition to improvements in functional capacity. Although the benefit of aldosterone inhibition is evident, adverse effects, such as hyperkalaemia and renal dysfunction, are associated with this therapy. Regular patient follow-up is essential for the prevention, early detection and prompt treatment of adverse effects, drug interactions and clinical deterioration.