LAUSR

Ferreira et al. review treatment with mineralocorticoid receptor antagonists (MRAs) in patients with heart failure (HF).1 Randomized controlled trials have shown that these drugs are effective in most of the patients with HF and reduced ejection fraction (HFrEF), including those with mild to moderate renal dysfunction or with hypokalaemia or mild hyperkalaemia.1 New MRAs and/or drugs preventing hyperkalaemia may further increase the indication to MRAs.2–4 Different from HFrEF, better patient selection seems warranted in those showing HF with preserved ejection fraction (HFpEF). The trial conducted in these patients, the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT), showed marked geographical differences.5,6 Spironolactone had favorable effects in patients in the prespecified randomization stratum with high NT-proBNP levels at baseline, and these patients with HFpEF and high BNP levels may be considered as potential targets for treatment with MRAs.1,7 Further indications to MRAs may come from studies in patients with acute HF at high risk of events and, on the opposite side of the spectrum, from studies in asymptomatic patients with increased markers of fibrosis, cardiac damage, or inflammation.1