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Antialdosteronics renaissance in the contemporary cardiology


Authors: M. Štejfa
Published in: Kardiol Rev Int Med 2005, 7(1): 21-24

Overview

We present an overview on synthesis and effects of aldosterone and their competitive inhibitors spironolactone and eplerenone. We briefly mention the indications, contraindications and adverse effects of the nonspecific inhibitor spironolactone in patients with primary and secondary hyperaldosteronism and its significance in hypertension treatment. Small doses of spironolactone (25 mg daily) in chronic heart failure NYHA II–IV represent a new indication, where the antiproliferative effect on progression of heart failure takes place (RALES study). Eplerenon is a specific inhibitor and presents a minimum of adverse effects. It was successfully tested in patients with hypertensive left ventricular hypertrophy (4E study) and in patients suffering from chronic heart failure (the EPHESUS study).

Keywords:
aldosterone – spironolactone – eplerenone – chronic heart failure – left ventricular hypertrophy – hypertension


Sources

1. Biollaz J et al. Anti­hy­pertensi­ve the­ra­py with MK421. J Cardio­vasc Pharma­col 1982; 4(6): 966–972.

2. Bozkurt B et al. Compli­ca­tions of inappropria­te use of spi­ro­no­lacto­ne in heart failu­re. J Am Coll Cardiol 2003; 41(2): 211–214.

3. Packer M. The neuro­hu­mo­ral hy­pothe­sis: a theo­ry to explain the me­cha­nism of di­sea­se progression in heart failu­re. J Am Coll Card 1992; 20: 248–254.

4. Pitt B et al. The effect of spi­ro­no­lacto­ne on mor­bi­di­ty and morta­li­ty in pa­tiens with se­ve­re heart failu­re. N Engl Med J 1999; 341: 709–717.

5. Pitt B et al. The EPHE­SUS trial: eple­re­non in pa­tients with heart failu­re due to systo­lic dysfunction compli­ca­ting acu­te myocardial infarction: eple­re­non post–acu­te myocardial infarction heart failu­re effi­ca­cy and survi­val stu­dy. Cardio­vasc Drug Ther 2001; 15: 79–87.

6. Pitt B et al. Effi­ca­cy and sa­fe­ty of eple­re­no­ne, ena­lapril and eple­re­no­ne/ena­lapril combi­na­tion the­ra­py in pa­cients with left ventri­cu­lar hy­pertrophy. Am J Hy­pertens 2002; 15: 23.

7. Pitt B et al. Eple­re­non post–acu­te myocardial infarction heart failu­re effi­ca­cy and survi­val stu­dy. N Engl J Med 2003; 348: 1309–1321.

8. Struthers AD. Aldoste­ro­ne esca­pe du­ti­ny angio­tensin–converting enzy­me the­ra­py in chro­nic heart failu­re. J Cardiac Failu­re 1996; 2(1): 47–54.

9. Swedberg K et al. Hormo­nes re­gu­la­ting function in pa­tients with se­ve­re congesti­ve heart failu­re and their re­la­tion to morta­li­ty. Circu­la­tion 1990; 82(5): 1730–1736.

10. We­ber KT. Aldoste­ro­ne and spi­ro­no­lacto­ne in heart failu­re. N Engl Med J 1999; 341: 753–755.

11. Wi­dimský J et al. Impro­ve­ment of heart failu­re 2. Cor Va­sa 2001; 43: 345–352.

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Paediatric cardiology Internal medicine Cardiac surgery Cardiology
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