#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Aldosterone Blockade in the Treatment of Refractory Heart Failure. Spironolactone - itsRediscovery and its Role in Intermittent Diuretic Treatment


Authors: P. Jerie
Published in: Prakt. Lék. 2002; (7): 407-411
Category:

Overview

Spironolactone, a competitive inhibitor of aldosterone, in addition to standard therapy, reducesthe risk of morbidity and death in patients with severe heart failure, as shown in RandomizedAldactone Evaluation Study (RALES). The results also emphasise that chronic treatment withACE inhibitors leads to an increase of aldosterone production. In selected patients withrefractory oedema, the effect of spironolactone (aldactone) was shown already in the sixties. Byincreasing the elimination of sodium and saving potassium, spironolactone restores the balanceof sodiumand potassium and the sensitiveness to thiazide diuretics.With triamterene, a potassium-sparing drug via a mechanism independent of aldosterone, the same effect can be demonstrated.Since diuretics lose their efficacy during long-term treatment, we have advocated anintermittent diuretic program with resting periods and alternative use of diuretics withdifferent mechanisms of action. When using combined treatment with ACE inhibitors, strictcontrol of potassium plasma levels is necessary. In critically ill patients, metabolic acid-basedisturbances and hypoalbuminaemia are to be corrected.

Key words:
spironolactone - intractable heart failure - refractory oedema - intermittent diuretictherapy - triamterene - acetazolamide - eplerenone - aldosterone escape.

Full text is not available online.
If interested in a scan of this journal, contact NTO ČLS JEP.

Labels
General practitioner for children and adolescents General practitioner for adults
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#