title: Mineralocorticoid receptor antagonists in patients with heart failure: current experience and future perspectives.
abstract: The 2016 European Society of Cardiology Heart Failure society as well as the 2016 American Heart Association/American College of Cardiology/Heart Failure Society of America heart failure (HF) guidelines confirm the class I indication for mineralocorticoid receptor antagonists (MRAs) in patients with chronic HF and a reduced left ventricular ejection fraction (HF-REF). MRAs in addition to an angiotensin converting enzyme inhibitor (ACEi), or an angiotensin receptor antagonist if an ACEi is not tolerated, along with a beta receptor antagonist and a diuretic (if required for congestion relief) make up the baseline therapy for all patients with chronic HF-REF. However, despite the finding that MRAs have been shown to reduce mortality as well as total and repeated hospitalizations in all patients with chronic HF-REF, as well as their class I indication in international guidelines, their use in guideline eligible patients remains suboptimal. Although much has been written about the mechanisms and role of MRAs in HF, this article will review the clinical studies and mechanisms thought responsible for their benefits in an attempt to increase their use in guideline eligible patients with HF as well as to provide the basis for understanding potential new opportunities for their use in patients with HF.
authors.affiliation: University of Michigan School of Medicine, Ann Arbor, MI, USA bpitt@med.umich.edu.
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.affiliation: INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy 54500, France.
authors.forename: João
authors.initials: J
authors.lastname: Pedro Ferreira
authors.affiliation: INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy 54500, France.
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
mesh_terms: D002309:Cardiology; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000494:pharmacology*; D013318:Stroke Volume / Q000187:drug effects*
chemical_list: D000451:Mineralocorticoid Receptor Antagonists
keywords: Heart failure; Mineralocorticoid receptor antagonists; Trials