Treatment of Heart Failure with Spironolactone — Trial and Tribulations

The application of evidence based on the results of clinical trials is a key aim of modern medical practice. Viewed from that perspective, the findings of Juurlink and colleagues in this issue of the Journal (pages 543–551) could be considered encouraging. The Randomized Aldactone Evaluation Study (RALES) showed that, when added to standard treatment (including an angiotensin-converting–enzyme ACE inhibitor), a low dose of the aldosterone antagonist spironolactone reduced the risk of death by 30 percent over an average follow-up period of two years among carefully selected patients with current or recent heart failure of New York Heart Association (NYHA) functional . . .