Rajagopalan Sanjay, Pitt Bertram
University of Michigan School of Medicine, Ann Arbor, MI, USA.
Med Clin North Am. 2003 Mar;87(2):441-57. doi: 10.1016/s0025-7125(02)00183-9.
Based upon the results of the RALES trial and accumulating evidence about the role of aldosterone and aldosterone receptor antagonism in various disease states, the authors anticipate that aldosterone receptor antagonists will become standard therapy, along with ACE inhibitors and beta-adrenergic receptor blocking agents, in patients with heart failure that is caused by systolic left ventricular dysfunction. Furthermore, the prospect of the use of these agents in other disease states that have implicated an activated rennin-angiotensin-aldosterone cascade, such as diastolic dysfunction, aging, and atherosclerosis, remains to be tested. Until further data from well-designed, prospective, randomized trials are available, the use of aldosterone receptor antagonists should be restricted to patients with severe or progressive heart failure caused by systolic left ventricular dysfunction in whom serum creatinine level is < or = 2.0 mg/dL and serum potassium levels are < 5.0 meq/L at baseline.
基于RALES试验的结果以及有关醛固酮和醛固酮受体拮抗剂在各种疾病状态中作用的越来越多的证据，作者预计醛固酮受体拮抗剂将与ACE抑制剂和β-肾上腺素能受体阻滞剂一起，成为由收缩期左心室功能不全引起的心力衰竭患者的标准治疗方法。此外，在其他涉及肾素-血管紧张素-醛固酮级联激活的疾病状态（如舒张功能障碍、衰老和动脉粥样硬化）中使用这些药物的前景仍有待检验。在获得来自设计良好的前瞻性随机试验的进一步数据之前，醛固酮受体拮抗剂的使用应仅限于由收缩期左心室功能不全引起的严重或进行性心力衰竭患者，这些患者基线时血清肌酐水平≤2.0mg/dL且血清钾水平<5.0meq/L。
