Optimizing Cardiovascular Care With Mineralocorticoid Receptor Antagonists

- Mineralocorticoid receptor antagonists (MRAs) reduce sodium/water reabsorption and enhance potassium retention in kidneys.
- MRAs can help blunt the physiologic phenomenon known as “aldosterone escape.”
- MRAs have been shown to reduce blood pressure in resistant hypertension.
- Studies show a reduction in morbidity/mortality with MRA use in post-acute coronary syndrome and heart failure with reduced ejection fraction.
- Morbidity reductions have been shown when MRAs are used in the heart failure with preserved ejection fraction population.

Mineralocorticoid receptor antagonists (MRAs) block the action of aldosterone at receptors in the kidneys, causing increased sodium and water excretion in exchange for potassium retention. There are 4 treatment groups in the cardiovascular population that have shown benefit with MRA therapy: resistant hypertension, post-acute coronary syndromes, heart failure with reduced ejection fraction, and heart failure with preserved ejection fraction. Serum potassium and kidney function should be monitored closely, especially if a patient is on a concomitant angiotensin-converting enzyme inhibitor, an angiotensin II receptor blocker, or direct renin inhibitor therapy.