Chapter

Aldosterone antagonists

Sushma Rekhraj, Benjamin R. Szwejkowski and Allan Struthers

in Oxford Textbook of Heart Failure

Published on behalf of Oxford University Press

ISBN: 9780199577729
Published online July 2011 | e-ISBN: 9780199697809 | DOI: http://dx.doi.org/10.1093/med/9780199577729.003.0039

Series: Oxford Textbooks

Aldosterone antagonists

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Heart failure (HF) is a condition which is associated with a highmorbidity and mortality rate despite advancements in treatmentoptions such as angiotensin converting enzyme (ACE) inhibitorsand β -blockers. Half of all HF patients are dead within 4 years.Numerous neurohormonal mechanisms are involved in the pathophysiologyof HF including the renin–angiotensin–aldosteronesystem (RAAS), the sympathetic nervous system, and argininevasopressin (AVP). With regards to the RAAS, plasma aldosteronelevels are 20-fold higher in HF than in normal individuals. Innormal individuals with normal sodium intake, plasma aldosteronelevels are 5–15 ng/dL (139–416 pmol/L) compared to plasma levels up to 300 ng/dL (8322 pmol/L) in HF patients. Aldosterone has been confirmed to play a pivotal role in the HF syndromeas highlighted by two landmark studies, RALES and EPHESUS. Inthe past, the importance of aldosterone was underappreciated asit was falsely assumed that ACE inhibitors will block aldosteronesynthesis. However, further studies have found this not to be true.

Chapter.  4961 words.  Illustrated.

Subjects: Cardiovascular Medicine

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