University of South Florida, Tampa, FL 33647, USA.
J Cardiovasc Pharmacol Ther. 2011 Jun;16(2):150-9. doi: 10.1177/1074248410387606. Epub 2010 Dec 15.
Aldosterone antagonists represented by nonselective spironolactone and mineralocorticoid-selective eplerenone are approved for treatment of symptomatic heart failure with reduced systolic function. Their cardioprotective, antifibrotic, and antiarrhythmic effects have been proven in animal experiments, and their effects on morbidity and mortality have been demonstrated in randomized clinical trials. Yet, they remain the most underutilized of all classes of medications for heart failure, primarily because of fear of hyperkalemia. Thorough patient screening and selection is the key for minimizing risks and optimizing benefits from these drugs. Ongoing trials will demonstrate whether the indication for aldosterone antagonists can be expanded to less severe heart failure or patients with preserved systolic function.
醛固酮拮抗剂，如非选择性螺内酯和选择性盐皮质激素受体拮抗剂依普利酮，被批准用于治疗有症状的收缩性心力衰竭。在动物实验中已经证实了它们的心脏保护、抗纤维化和抗心律失常作用，随机临床试验也证实了它们对发病率和死亡率的影响。然而，它们仍然是心力衰竭治疗中所有药物类别中使用最少的，主要是因为担心高钾血症。彻底的患者筛选和选择是最大限度降低这些药物风险和优化获益的关键。正在进行的试验将表明醛固酮拮抗剂的适应证是否可以扩展到更轻的心力衰竭或有收缩功能保留的心力衰竭患者。
