Aldosterone receptor blockers in the treatment of heart failure

被引：1

作者：

Deswal A. ^{[1
]}

Yao D. ^{[1
]}

机构：

[1] Michael E. DeBakey VA Med. Center, Section of Cardiology, Houston, TX 77030

来源：

Current Treatment Options in Cardiovascular Medicine | 2004年 / 6卷 / 4期

关键词：

Aldosterone; Serum Potassium; Angiotensin Receptor Blocker; Main Drug Interaction; Eplerenone;

D O I：

10.1007/s11936-004-0034-3

中图分类号：

学科分类号：

摘要：

Heart failure is associated with neurohormonal activation, including activation of the renin-angiotensin-aldosterone system. Plasma aldosterone levels are elevated in patients with heart failure in spite of the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers because of angiotensin-independent stimuli for aldosterone production. In addition to its long recognized role in sodium retention, aldosterone has a number of other deleterious effects, including the increase in myocardial and vascular fibrosis and myocardial remodeling in patients with heart failure. Based on strong clinical trial data, low-dose aldosterone receptor blockers are recommended to improve morbidity and mortality in patients with severe chronic heart failure due to left ventricular systolic dysfunction and in patients with heart failure associated with left ventricular systolic dysfunction after acute myocardial infarction, and in patients already on standard therapy including ACE inhibitors (or angiotensin receptor blockers) and β blockers. In view of the potential for serious hyperkalemia with the use of aldosterone receptor blockers, it is essential to monitor serum potassium levels. Close adherence to the dosing regimens used in the clinical trials (RALES [Randomized Aldactone Evaluation Study] and EPHESUS [Eplerenone Post-AMI Heart Failure Efficacy and Survival Study]) is recommended. These agents should not be initiated in patients with severe renal insufficiency and closer monitoring is warranted in those with mild to moderate renal insufficiency or diabetes. Copyright © 2004 by Current Science Inc.

引用

页码：327 / 334

页数：7

共 27 条

[1]

2003 Heart and Stroke Statistical Update, (2003)

[2]

Weber K.T., Aldosterone and spironolactone in heart failure, N. Engl. J. Med., 341, pp. 753-755, (1999)

[3]

Weber K.T., Aldosterone in congestive heart failure, N. Engl. J. Med., 345, pp. 1689-1697, (2001)

[4]

Struthers A.D., Aldosterone escape during angiotensin-converting enzyme inhibitor therapy in chronic heart failure, J. Card. Fail., 2, pp. 47-54, (1996)

[5]

Zannad F., Alla F., Dousset B., Et al., Limitation of excessive extracellular matrix turnover may contribute to survival benefit of spironolactone therapy in patients with congestive heart failure: Insights from the randomized aldactone evaluation study (RALES), Circulation, 102, pp. 2700-2706, (2000)

[6]

Brilla C.G., Janicki J.S., Weber K.T., Impaired diastolic function and coronary reserve in genetic hypertension. Role of interstitial fibrosis and medial thickening of intramyocardial coronary arteries, Circ. Res., 69, pp. 107-115, (1991)

[7]

Klappacher G., Franzen P., Haab D., Et al., Measuring extracellular matrix turnover in the serum of patients with idiopathic or ischemic dilated cardiomyopathy and impact on diagnosis and prognosis, Am. J. Cardiol., 75, pp. 913-918, (1995)

[8]

Pitt B., Escape" of aldosterone production in patients with left ventricular dysfunction treated with an angiotensin converting enzyme inhibitor: Implications for therapy, Cardiovasc. Drugs Ther., 9, pp. 145-149, (1995)

[9]

McKelvie R.S., Yusuf S., Pericak D., Et al., Comparison of candesartan, enalapril, and their combination in congestive heart failure: Randomized Evaluation of Strategies for Left Ventricular Dysfunction (RESOLVD) pilot study: The RESOLVD pilot study investigators, Circulation, 100, pp. 1056-1064, (1999)

[10]

Brilla C.G., Matsubara L.S., Weber K.T., Anti-aldosterone treatment and the prevention of myocardial fibrosis in primary and secondary hyperaldosteronism, J. Mol. Cell Cardiol., 25, pp. 563-575, (1993)

← 1 2 3 →