Funder John W
Hudson Institute, Monash Medical Centre and Monash University, 27-31 Wright St Clayton, VIC, 3168, Australia.
F1000Res. 2017 Sep 22;6:1738. doi: 10.12688/f1000research.11887.1. eCollection 2017.
Spironolactone has been marketed for over half a century as a 'potassium-sparing diuretic', used primarily in patients with ascites. With the realization that primary aldosteronism is the most common (5-13%) form of secondary hypertension, it has become widely used as a mineralocorticoid receptor antagonist. More recently, in the wake of the RALES trial, spironolactone in addition to standard therapy has been shown to be very beneficial in heart failure with a reduced ejection fraction. Despite the failure of the TOPCAT trial, spironolactone is being increasingly used in diastolic heart failure (i.e. with a preserved ejection fraction). The third currently accepted role for spironolactone is in hypertension resistant to three conventional antihypertensives including a diuretic, where it has been proven to be effective, in contra-distinction to renal artery denervation. Finally, brief consideration will be given to 'areas in waiting' - pulmonary hypertension/fibrosis, cancer - where spironolactone may play very useful roles.
螺内酯作为一种“保钾利尿剂”已上市半个多世纪，主要用于腹水患者。随着人们认识到原发性醛固酮增多症是继发性高血压最常见（5%-13%）的形式，它已被广泛用作盐皮质激素受体拮抗剂。最近，在RALES试验之后，除标准治疗外，螺内酯已被证明对射血分数降低的心力衰竭非常有益。尽管TOPCAT试验失败了，但螺内酯在舒张性心力衰竭（即射血分数保留）中的应用越来越多。螺内酯目前被认可的第三个作用是用于对包括利尿剂在内的三种传统抗高血压药物耐药的高血压，在这种情况下，它已被证明是有效的，这与肾动脉去神经支配不同。最后，将简要考虑“有待探索的领域”——肺动脉高压/纤维化、癌症——在这些领域螺内酯可能发挥非常有用的作用。
