Anti-aldosterone therapy in the treatment of heart failure: new thoughts on an old hormone.
Activation of the renin-angiotensin-aldosterone system (RAAS) is a prominent feature of left ventricular dysfunction and plays an important role in the progression of chronic heart failure. Clinical and animal studies investigating agents that interrupt this hormonal system have focused primarily on the proximal constituents of the RAAS, namely angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists, and have largely neglected the possible pathological consequences of another hormone in the system, aldosterone. Clinical evidence indicates that aldosterone plays an important role in chronic heart failure, even when other RAAS inhibiting agents are employed. Moreover, animal studies have indicated that aldosterone, in addition to important renal effects, has direct cardiac and vascular effects. These data suggest that an anti-aldosterone therapeutic may provide important protection in chronic heart failure. Currently, only one therapeutic is available, spironolactone (Aldactone), and recent clinical studies support the contention that the addition of spironolactone to standard heart failure therapy provides additional benefit. A highly selective aldosterone receptor antagonist, eplerenone, is currently in clinical development. Data from this new agent should provide important evidence supporting the benefit of anti-aldosterone therapy in chronic heart failure, which may encourage physicians to include an anti-aldosterone agent in the armamentarium of therapeutics currently used to combat chronic heart failure.
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Delyani