What do aldosterone antagonists do

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Health Canada - Drugs and Health Products Provides health and medical information for Canadians to maintain and improve their health. Your ministry of health also offers health resources in your province or territory. Here are some tips for managing your medications. Donate now. What is this medication? Canadian brand names are in brackets. What does it do? Lower your blood pressure.

Can relieve shortness of breath. Reduce swelling and bloating. Make you pee more often. How do I take it? Baseline characteristics Average age 65 years Average EF - Randomized treatment groups Group 1 patients Placebo once daily Group 2 patients Spironolactone 25 - 50 mg a day average dose during the study was 26 mg Spironolactone was started at 25 mg once daily and increased after 8 weeks if deemed appropriate.

Primary outcome: All-cause mortality. Results Duration: After an average follow-up of 2 years, the trial was stopped early due to a clear benefit with spironolactone Outcome Placebo Spironolactone Comparisons Primary outcome Findings: Blockade of aldosterone receptors by spironolactone, in addition to standard therapy, substantially reduces the risk of both morbidity and death among patients with severe heart failure.

Randomized treatment groups Group 1 patients - Eplerenone 25 - 50 mg once daily average dose in study was Primary outcomes: 1. Death from any cause 2. Death from cardiovascular causes or hospitalization for heart failure, acute myocardial infarction, stroke, or ventricular arrhythmia. Findings: The addition of eplerenone to optimal medical therapy reduces morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure.

Randomized treatment groups Group 1 patients - Eplerenone 25 - 50 mg once daily average dose in study was 39 mg Group 2 patients - Placebo once daily Eplerenone was started at 25 mg once daily and increased after 4 weeks. Primary outcome: Composite of death from cardiovascular causes or hospitalization for heart failure.

Results Duration: After a median follow-up of 21 months, the trial was stopped early due to a clear benefit with eplerenone Outcome Eplerenone Placebo Comparisons Primary outcome Lower risk of sudden cardiac death and death from progressive heart failure was attributable to the above results.

This is the next major mortality trial in the world of ARAs. The mean follow-up was 16 months on this event-driven trial. There was significant reduction in sudden cardiac death and heart failure hospitalization. Serious hyperkalemia was significantly higher in the eplerenone group 5. Antiandrogenic side effects such as gynecomastia was not similar among the two groups. Twenty-five percent of all deaths in this study happened within the first 30 days after randomization, which emphasizes the need for early initiation of ARAs after acute myocardial infarction, when indicated.

This is the recently published major trial of ARAs. These patients were randomized to eplerenone and a placebo. The inclusion criteria was made very specific to achieve higher event rates and is beyond the scope of this review.

The primary endpoint was death from cardiovascular causes or heart failure hospitalizations. The median follow-up was 21 months. The primary endpoint occurred less frequently in the eplerenone group as did all-cause mortality and cardiovascular mortality. Although the Kaplan-Meier curve for all-cause mortality showed separation only after a year, the one for heart failure hospitalizations showed separation within weeks. The incidence of hyperkalemia was significantly higher in the eplerenone group.

There was no difference between groups with antiandrogenic symptoms. Spironolactone: Five decades ago, Cella tried to combine the elements of progesterone and digoxin for the antimineralocorticoid and cardiotonic effect, respectively, thereby developing a nonselective aldosterone receptor antagonist called spironolactone.

Spironolactone is very helpful in hypertension and heart failure management. But the main limiting factor is its progestational and antiandrogenic side effects. Eplerenone: To overcome this limitation, a selective aldosterone receptor antagonist was developed in by Grob. Although the antiandrogenic action is negligible, no significant difference in drug efficacy was noted in clinical trials.

There are no large-scale, head-to-head comparison trials between spironolactone and eplerenone in the heart failure population. The factors influencing the choice between these two agents in clinical practice would be:. Price difference: Although both drugs are available in generic form, the cost of eplerenone tablets is at least three to four times higher than spironolactone tablets. Heart failure management has changed considerably over last 3 decades.

When neurohormonal hypothesis was introduced, multiple new classes of medications that interfere with RAAS emerged. But in the last decade, this was proven to be wrong.