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This article explores how baseline aldosterone concentrations influence the efficacy and outcomes of mineralocorticoid receptor antagonists (MRAs) in heart failure patients, highlighting the need for tailored therapeutic approaches.
This meta-analysis of four placebo-controlled trials reveals no significant difference in the efficacy and safety of mineralocorticoid receptor antagonists between Black and non-Black patients with heart failure, regardless of heart failure
A Danish nationwide cohort study found that initiating SGLT2 inhibitors rather than mineralocorticoid receptor antagonists (MRAs) as the third foundational therapy after RASI and beta‑blocker in HFrEF was associated with lower all‑cause and
A 2025 systematic review and meta-analysis found that patients with primary aldosteronism whose renin rose after mineralocorticoid receptor antagonist therapy had substantially lower cardiovascular event rates and possibly lower mortality,
Steroidal mineralocorticoid receptor antagonists show minimal impact on cardiovascular mortality in dialysis patients, with limited safety concerns and evidence gaps in subgroups and non-steroidal agents.
This review consolidates evidence from the ACHIEVE trial and related studies evaluating spironolactone’s efficacy and safety in patients undergoing maintenance dialysis, highlighting lack of cardiovascular benefit and discussing futur
The ALCHEMIST trial reveals spironolactone does not improve cardiovascular outcomes in high-risk chronic haemodialysis patients, aligning with a meta-analysis that challenges the benefit of mineralocorticoid receptor antagonists in this pop
