Abstract
Spironolactone has been marketed for over half a century as a ‘potassium-sparing diuretic’, used primarily in patients with ascites. With the realization that primary aldosteronism is the most common (5-13%) form of secondary hypertension, it has become widely used as a mineralocorticoid receptor antagonist. More recently, in the wake of the RALES trial, spironolactone in addition to standard therapy has been shown to be very beneficial in heart failure with a reduced ejection fraction. Despite the failure of the TOPCAT trial, spironolactone is being increasingly used in diastolic heart failure (i.e. with a preserved ejection fraction). The third currently accepted role for spironolactone is in hypertension resistant to three conventional antihypertensives including a diuretic, where it has been proven to be effective, in contra-distinction to renal artery denervation. Finally, brief consideration will be given to ‘areas in waiting’ – pulmonary hypertension/fibrosis, cancer – where spironolactone may play very useful roles.
Highlights
Spironolactone (AldactoneR) is the prototypic mineralocorticoid receptor antagonist (MRA), patented over 50 years ago and still in widespread clinical use
Third and fourth generation MRAs are in development – as potent as spironolactone, as selective as eplerenone, non-steroidal, cheap to manufacture and with a long patent life; fourth generation are as above, but renal tubule sparing or otherwise tissue-selective
This brief review will focus on established indications for spironolactone use – primary aldosteronism (PA), heart failure, resistant hypertension (ReHT) – in cardiovascular disease
Summary
Spironolactone (AldactoneR) is the prototypic mineralocorticoid receptor antagonist (MRA), patented over 50 years ago and still in widespread clinical use. Third and fourth generation MRAs are in development – as potent as spironolactone, as selective as eplerenone, non-steroidal, cheap to manufacture and (hopefully) with a long patent life; fourth generation are as above, but renal tubule sparing (lessening the chance of hyperkalemia) or otherwise tissue-selective This brief review will focus on established indications for spironolactone use – primary aldosteronism (PA), heart failure, resistant hypertension (ReHT) – in cardiovascular disease. In a subsequent treatment to effect study on essential hypertensives where patients were given eplerenone (50/100/200 mg/day – i.e. doses equivalent to or less than that of spironolactone), blood pressure fell to a similar extent, but plasma [K+] was on average elevated by only ≤0.2 meq/L11. Grant information The author(s) declared that no grants were involved in supporting this work
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
