Aldosterone receptor antagonists (MRAs) for HF

What is the basic MOA of MRAs?

blockade of aldosterone receptors

What are the 4 mechanisms of cardiac death?

• coronary endothelial dysfunction

• LV abnormalities

• extrinsic arrhythmogenic influences

• autonomic dysfunction

What is the effect of aldosterone receptor antagonists and how do they happen?

• increased sodium and water retention leads to congestive symptoms and cardiac remodelling so blocking these receptors has the opposite effect

• increased proliferative effects lead to hypertrophy, apoptosis and fibrosis lead to cardiac remodelling, so MRAs block that

What is the clinical use of MRAs for?

All patients with heart failure with reduced ejection fraction.

Which MRAs are licensed for use in HF in the UK?

spironolactone and eplerenone

What are the possible adverse effects of MRAs?

• impotence and gynaecomastia

• menstrual disorders and hirsutism

• hyperkalaemia