Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis.
JAMA Cardiol. 2016 Aug 1;1(5):607-12. doi: 10.1001/jamacardio.2016.1878.
Heart failure (HF), with or without reduced ejection fraction, and multidrug-resistant hypertension (RHT) are major worldwide health problems of ever-increasing proportions. The mineralocorticoid receptor antagonists (MRAs) spironolactone and eplerenone have proved valuable additions to the overall management of these disorders in patients without significant renal dysfunction.
Neurohormonal activation, including aldosteronism, in HF and RHT, has provided the pathophysiologic basis for the inclusion of MRA in the overall management of these disorders and the respective survival benefit and control of blood pressure. Furthermore, MRAs attenuate the appearance of secondary hyperparathyroidism that accompanies excretory Ca2+ losses induced by aldosteronism in which elevated parathyroid hormone levels raise the risk of adverse cardiovascular events and atraumatic bone fracture. Serial surveillance of serum electrolytes and creatinine levels is mandated to avoid serious hyperkalemia (potassium concentration >5.5 mEq/L) and its attendant risks in patients receiving MRAs.
Mineralocorticoid receptor antagonists are a valuable addition to the practice of medicine. Their judicious use in patients with HF or RHT can improve treatment of these patients.
心力衰竭（HF），无论射血分数降低与否，以及多药耐药性高血压（RHT）都是全球范围内日益严重的主要健康问题。醛固酮受体拮抗剂（MRA）螺内酯和依普利酮已被证明是治疗这些无明显肾功能障碍患者的重要方法。
HF 和 RHT 中的神经激素激活，包括醛固酮症，为 MRA 纳入这些疾病的整体治疗以及各自的生存获益和血压控制提供了病理生理基础。此外，MRA 可减轻继发性甲状旁腺功能亢进症的发生，继发性甲状旁腺功能亢进症是由醛固酮症引起的钙排泄增加引起的，其中甲状旁腺激素水平升高会增加不良心血管事件和无创伤性骨折的风险。为避免接受 MRA 治疗的患者发生严重高钾血症（血钾浓度>5.5mEq/L）及其相关风险，必须对血清电解质和肌酐水平进行连续监测。
醛固酮受体拮抗剂是医学实践的重要补充。在 HF 或 RHT 患者中合理使用它们可以改善这些患者的治疗效果。
