Aldosterone antagonists in heart failure

Previously aldosterone was only thought to exert damaging effects on the failing heart owing to adverse compensatory measures in fluid homeostasis. However, recent evidence has suggested that the mineralcorticoid receptor for aldosterone is also present in the vasculature and failing heart, and it is here that aldosterone’s role is of more significance in relation to worsening cardiac dysfunction. Aldosterone blockade with spironolactone has been strongly correlated with reduced mortality and morbidity rates in patients with chronic heart failure caused by systolic left ventricular dysfunction and, more recently, aldosterone blockade with eplerenone has also been indicated in cases of heart failure after acute myocardial infarction. The emerging evidence for the use of aldosterone blockade in the cardiac patient has also highlighted the need for careful patient selection and monitoring to prevent adverse effects, in particular from hyperkalaemia.