High plasma concentrations of aldosterone are frequent in patients with moderate to severe heart failure and contribute to sodium retention, potassium loss, sympathetic activation, myocardial fibrosis, and baroreceptor dysfunction. ACE inhibition usually results in only a transient decrease in aldosterone concentrations, probably because a major source of aldosterone is reduced hepatic clearance rather than angiotensin dependent adrenal secretion. The recent RALES study11 has shown that the addition of 25 mg of spironolactone to conventional treatment in patients with an ejection fraction < 35% and a history of NYHA class IV heart failure is associated with a 30% reduction in the overall risk ofdeath. Hospitalisation rates for cardiac causes and functional status also improved, and serious hyperkalaemia was infrequent in patients with a serum creatinine <221 |imol/l. The drug should be considered in all patients presenting with moderate to severe heart failure symptoms.

0 0

Post a comment