Susan E. Miller, DNP, RN, PCCN Assistant Professor, School of Nursing, Acute and Tertiary Care Department, University of Pittsburgh, Pennsylvania. René J. Alvarez Jr, MD, FACC, FAHA Professor of Medicine, Medical Director, Advanced Heart Failure/Cardiac Transplantation, Vice Chief, Section of Cardiology, and Assistant Dean for Minority Faculty Affairs, School of Medicine, Temple University, Philadelphia, Pennsylvania.
J Cardiovasc Nurs. 2013 Nov-Dec;28(6):E47-54. doi: 10.1097/JCN.0b013e3182675e2a.
Chronic, systolic heart failure is an increasing and costly health problem, and treatments based on pathophysiology have evolved that include the use of aldosterone antagonists.
Advances in the understanding of neurohormonal responses to heart failure have led to better pharmacologic treatments. The steroid hormone aldosterone has been associated with detrimental effects on the cardiovascular system, such as ventricular remodeling and endothelial dysfunction. This article will review the literature and guidelines that support the use of aldosterone antagonists in the treatment of chronic, systolic heart failure.
Aldosterone antagonists are life-saving drugs that have been shown to decrease mortality in patients with New York Heart Association class III to IV heart failure and in patients with heart failure after an acute myocardial infarction. Additional studies are being conducted to determine if the role of aldosterone antagonists can be expanded to patients with less severe forms of heart failure.
Aldosterone antagonists are an important pharmacologic therapy in the neurohormonal blockade necessary in the treatment of systolic heart failure. These drugs have been shown to decrease mortality and reduce hospital readmission rates. The major complication of aldosterone antagonists is hyperkalemia, which can be avoided with appropriate patient selection and diligent monitoring.
慢性收缩性心力衰竭是一个日益严重且代价高昂的健康问题，基于病理生理学的治疗方法已经发展，包括使用醛固酮拮抗剂。
对心力衰竭神经激素反应的认识的进步带来了更好的药物治疗。甾体激素醛固酮与心血管系统的不良影响有关，如心室重构和内皮功能障碍。本文将综述支持在慢性收缩性心力衰竭治疗中使用醛固酮拮抗剂的文献和指南。
醛固酮拮抗剂是救命药物，已被证明可降低纽约心脏协会 III 至 IV 级心力衰竭患者和急性心肌梗死后心力衰竭患者的死亡率。正在进行更多的研究，以确定醛固酮拮抗剂的作用是否可以扩展到病情较轻的心力衰竭患者。
醛固酮拮抗剂是治疗收缩性心力衰竭时神经激素阻断所必需的重要药物治疗。这些药物已被证明可降低死亡率并降低住院再入院率。醛固酮拮抗剂的主要并发症是高钾血症，通过适当的患者选择和认真监测可以避免。
