Abstract
The Randomised Aldosterone Evaluation Study (RALES) was recently terminated prematurely because it demonstrated that spironolactone was superior to placebo at reducing death in patients with moderate to severe chronic heart failure who were already being treated with standard therapy including an ACE inhibitor. This is a very important finding as it should directly influence the clinical management of patients with moderate to severe CHF. Its other major impact is that it should be possible to use the RALES results to provide important mechanistic clues as to why the CHF disease process progresses towards death. This article will therefore address the question of what are the possible mechanisms whereby spironolactone improves mortality in CHF?
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