College of Pharmacy, Western University of Health Sciences, Pomona, California 91766, USA.
Pharmacotherapy. 2012 Sep;32(9):827-37. doi: 10.1002/j.1875-9114.2012.01104.x.
Despite numerous pharmacologic and nonpharmacologic treatment strategies, heart failure remains a complex, progressive disorder with significant morbidity and mortality. Angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and β-blockers have been used as routine treatment options for heart failure for the majority of patients with left ventricular systolic dysfunction who tolerate these agents. Mineralocorticoid receptor antagonists (MRAs) have also demonstrated significant benefits in the treatment of heart failure, which include a reduction in sudden cardiac death and ventricular remodeling; however, these agents have not been recommended for most patients with heart failure. In the most recent American College of Cardiology Foundation and American Heart Association guidelines, MRAs are recommended for patients with New York Heart Association class III or IV symptoms or previous acute myocardial infarction, provided an absence of contraindications or risk factors for developing hyperkalemia. Based on more recent evidence, it is likely that future recommendations and guidelines will further expand the use of MRAs to patients with mild heart failure as well. These agents have the potential to be recommended nearly as universally as ACE inhibitors and β-blockers because of the potential to reduce mortality and hospital admissions for heart failure. The risk of hyperkalemia should be carefully assessed when using these drugs; nonetheless, new strategies being developed may reduce the occurrence of hyperkalemia as well.
尽管有许多药物和非药物治疗策略，心力衰竭仍然是一种复杂的、进行性的疾病，具有显著的发病率和死亡率。血管紧张素转换酶（ACE）抑制剂、血管紧张素 II 受体阻滞剂（ARB）和β受体阻滞剂已被用作大多数有左心室收缩功能障碍且能耐受这些药物的心力衰竭患者的常规治疗选择。醛固酮受体拮抗剂（MRA）也已被证明对心力衰竭的治疗有显著益处，包括降低心脏性猝死和心室重构的风险；然而，这些药物并未被推荐用于大多数心力衰竭患者。在最近的美国心脏病学会基金会和美国心脏协会指南中，MRA 被推荐用于纽约心脏协会（NYHA）分级 III 或 IV 症状或既往急性心肌梗死的患者，如果没有禁忌症或发生高钾血症的风险因素。基于最近的证据，未来的建议和指南可能会进一步扩大 MRA 的使用范围，包括轻度心力衰竭患者。这些药物有可能像 ACE 抑制剂和β受体阻滞剂一样被广泛推荐，因为它们有可能降低心力衰竭患者的死亡率和住院率。在使用这些药物时，应仔细评估高钾血症的风险；尽管如此，正在开发的新策略可能会降低高钾血症的发生。
