KEY POINTS
Although caution is advised in starting ARAs, these drugs are commonly underused in heart failure.
Aldosterone “escape” can blunt the effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. This is the rationale for also using ARAs.
The major trials of ARAs in heart failure to date have been the Randomized Aldactone Evaluation Study (RALES), the Eplerenone Post-acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS), and the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF).
Close monitoring is essential when starting an ARA, as severe hyperkalemia and renal insufficiency can occur.