Mineralocorticoid receptor antagonists and therapeutic strategies of cardiovascular damage

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dc.coverageDOI: 10.4067/S0034-98872014000100010
dc.creatorVerdugo, Fernando J.
dc.creatorMontellano, Felipe A.
dc.creatorCarreño, Juan E.
dc.creatorMarusic, Elisa T.
dc.date2014
dc.date.accessioned2025-11-18T19:54:10Z
dc.date.available2025-11-18T19:54:10Z
dc.description<p>In recent years, much attention has focused on the role of aldosterone and mineralocorticoid receptors (MRs) in the pathophysiology of hypertension and cardiovascular disease. Patients with primary aldosteronism, in whom angiotensin II levels are low, have a higher incidence of cardiovascular complications than patients with essential hypertension. The Randomized Aldactone Evaluation Study (RALES) demonstrated that adding a non-specific MR antagonist, spironolactone, to a standard therapy that included angiotensin-converting enzyme (ACE) inhibitors, loop diuretics, and digoxin, significantly reduced morbidity and mortality in patients with moderate to severe heart failure. Similarly, the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) showed that the addition of a selective MR antagonist (ARM), eplerenone, to an optimal medical therapy reduces morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure. These data suggest that aldosterone induces cardiac injury through activation of MRs and support the notion that MR blockade has beneficial effects on aldosterone-dependent cardiac injury, through mechanisms that cannot be simply explained by hemodynamic changes. Although, MRA are highly effective in patients with heart failure, the risk of hyperkalemia should not be overlooked. Serious hyperkalemia events were reported in some MRA clinical trials; however these risks can be mitigated through appropriate patient selection, dose selection, patient education, monitoring, and follow-up.</p>eng
dc.descriptionIn recent years, much attention has focused on the role of aldosterone and mineralocorticoid receptors (MRs) in the pathophysiology of hypertension and cardiovascular disease. Patients with primary aldosteronism, in whom angiotensin II levels are low, have a higher incidence of cardiovascular complications than patients with essential hypertension. The Randomized Aldactone Evaluation Study (RALES) demonstrated that adding a non-specific MR antagonist, spironolactone, to a standard therapy that included angiotensin-converting enzyme (ACE) inhibitors, loop diuretics, and digoxin, significantly reduced morbidity and mortality in patients with moderate to severe heart failure. Similarly, the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) showed that the addition of a selective MR antagonist (ARM), eplerenone, to an optimal medical therapy reduces morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure. These data suggest that aldosterone induces cardiac injury through activation of MRs and support the notion that MR blockade has beneficial effects on aldosterone-dependent cardiac injury, through mechanisms that cannot be simply explained by hemodynamic changes. Although, MRA are highly effective in patients with heart failure, the risk of hyperkalemia should not be overlooked. Serious hyperkalemia events were reported in some MRA clinical trials; however these risks can be mitigated through appropriate patient selection, dose selection, patient education, monitoring, and follow-up.spa
dc.identifierhttps://investigadores.uandes.cl/en/publications/23c917ba-0dff-4c69-826d-7ebe5600727a
dc.identifier.urihttps://repositorio.uandes.cl/handle/uandes/58611
dc.languageeng
dc.rightsinfo:eu-repo/semantics/openAccess
dc.sourcevol.142 (2014) nr.1 p.61-71
dc.subjectAldosterone
dc.subjectCardiovascular diseases
dc.subjectMineralocorticoid receptor antagonists
dc.subjectSpironolactone
dc.subjectSDG 3 - Good Health and Well-being
dc.titleMineralocorticoid receptor antagonists and therapeutic strategies of cardiovascular damageeng
dc.titleAplicaciones y proyecciones de los antagonistas del receptor de mineralocorticoides en el tratamiento de patologías cardiovascularesspa
dc.titleMineralocorticoid receptor antagonists and therapeutic strategies of cardiovascular damageeng
dc.typeReview articleeng
dc.typeArtículo de revisiónspa
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