While trials have reported on the clinical benefit of co-prescribing aldosterone antagonist and renin-angiotensin system (RAS) drugs in heart failure patients, follow up studies found inappropriate monitoring and higher rates of complications, such as hyperkalaemia, in clinical practice compared to … What they do. Aldosterone antagonist is publicized as effective in reducing mortality in patients with heart failure (HF) or post myocardial infarction (MI). The Comparative Effectiveness of Therapies for Heart Failure (COMPARE- HF) program used a national clinical registry linked to Medicare claims data to examine the clinical effectiveness of therapies such as aldosterone antagonists and associations with long-term outcomes of older patients discharged from a hospitalization for heart failure [6]. Eplerenone, a new aldosterone antagonist, has been studied in the past few years. The potent mineralocorticoid aldosterone has a multifaceted role in the pathogenesis of congestive heart failure. Aldosterone receptor antagonists, also called MRAs, block the effects of a hormone produced naturally by your adrenal glands which can cause your heart failure to get worse. Background and Objectives Sudden cardiac death (SCD) is a severe burden of modern medicine. Aldosterone antagonists are recommended in patients who recovered from an ST elevation MI without substantial renal dysfunction (defined as creatinine . Aldosterone Receptor Antagonists (ARAs) in heart failure. With a relative risk reduction in mortality of about 25%, 1,2 aldosterone antagonists compare favourably to other agents used in congestive HF: about 29% for β-blockers 5 and 23% for ACEIs. Aldosterone receptor antagonists are proven to be beneficial in heart failure patients even if they are already on angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs). f) In dose equivalent to enalapril 10 mg twice daily Context: Aldosterone antagonists are recommended for patients with moderate to severe heart failure (HF) and systolic dysfunction. Aldosterone antagonist prevents the binding of aldosterone at the mineralocorticoid receptors, resulting in the failure of production of mediator protein (AIPs); thus, the antagonist-receptor complex inhibits the exchange of Na + for K + and H + ions; eventually increases the excretion of Na + and water, while conserving K + and H + ions. Circulation. Sixty-two adult (mean +/- SD age 54 +/- 16 yrs) aldosterone antagonist-naïve patients with heart failure. ACC/AHA guidelines for Minimizing the Risk of Hyperkalemia in Patients Treated With Aldosterone-receptor Antagonists. Recent updates to heart failure guidelines suggest withholding aldosterone antagonist therapy in patients with a baseline serum potassium concentration exceeding 5.0 mmol/L. 8 American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) treatment guidelines recommend the use of an AA in all HF patients with an ejection fraction ≤35% and no known … Our study aimed to assess the efficacy of AAs on mortality including SCD, hospitalization admission and several common adverse effects. a Although the entry criteria for the trials of aldosterone-receptor antagonists included creatinine greater than 221.0 µmol/l (>2.5 mg/dl), the majority of patients had much lower creatinine levels; in 1 trial, 95% of patients had creatinine ?150.0 µmol/l (?1.7 mg/dl). Aldosterone Antagonist. Aldosterone receptor antagonists (ARAs) are a type of diuretic used in patients with CHF. 2.5mg% in men and 2.0 in women) or hyperkalemia who already are receiving an ACE inhibitor, have LVEF 40%, and have symptomatic heart failure or diabetes mellitus.. From: Medical Secrets (Fifth Edition), 2012 This analysis included 1703 (mean age, 72±10 years; 50% men; 78% white) patients with heart failure with preserved ejection fraction enrolled in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) Trial from the Americas who were treated for hypertension. These medicines cause the kidneys to get rid of extra water and they help to retain potassium by inhibiting secretion of potassium into distal tubule of the nephron[1]. Treatment with mineralocorticoid antagonist (MRA) has been tested in the recent randomized, double‐blind TOPCAT (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function) 6 trial. Aldosterone receptor antagonists affect the balance of water and salts going into your urine and are weak diuretics.They help lower blood pressure, reduce congestion and thus protect the heart. They also have other properties that can prevent heart failure from becoming worse, along with improving symptoms of heart failure. 70, – 76 d) With hospital admission for heart failure in the last six months or with elevated natriuretic peptides. Learn vocabulary, terms, and more with flashcards, games, and other study tools. However, aldosterone antagonist therapy may not be appropriate for all patients with heart failure. Yancy CW, Jessup M, Bozkurt B, et al. However, aldosterone antagonist therapy may not be appropriate for all patients with heart failure. Since that time, several case reports and case series have linked aldosterone antagonism in heart failure with life-threatening hyperkalemia, especially in combination with ACE inhibitors or ARBs. This may be related to the phenomenon of aldosterone escape, which refers to the tendency of circulating aldosterone levels to return to normal or supranormal levels during long-term ACE inhibitor therapy of chronic heart failure .