Cardioprotective effect of eplerenone

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Abstract

The negative impact of hyperaldosteronism in patients with congestive heart failure (CHF) is related not only to fluid retention but also to electrolyte imbalance. Aldosterone that can influence endothelium, vascular smooth muscle cells, and cardiomyocytes directly, induces fibrosis and hypertrophy that in turn promotes the diastolic dysfunction development and rhythm disturbance. Mineralocorticoid receptor (MCR) blockade is followed by left ventricular mass reduction that improves its contractile function and results in brain natriuretic peptide level reduction. EPHESUS and EMPHASIS-HF trials showed that adding MCR antagonists to ACE inhibitors and b-adrenoblockers additionally improves the clinical course and prognosis in patients with CHF. Early administration of eplerenone in patients with myocardial infarction with ST-segment elevation results in CHF development decrease. According to the latest guidelines on CHF treatment it is recommended to use threefold neurohormonal blockade - combination of renin-angiotensin-aldosterone system blockers (ACE inhibitors and angiotensin II receptor blockers) combined with b-adrenoblockers and MCR antagonists in patients with CHF after class II. This management regimen (including diuretics and cardiac glycoside prescription) improves not only patients’ quality of live but also disease prognosis. Spironolactone and eplerenone are considered equally effective. Though in clinical practice eplerenone an agent of choice because of its better tolerability and fewer side effects.

About the authors

A. A Kirichenko

Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation

Email: andrey.apollonovich@yandex.ru
д-р мед. наук, проф., зав. каф. терапии 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1

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