In the wake of the latest clinical guidelines - mineralocorticoid receptor antagonists in the treatment of chronic heart failure
https://doi.org/10.21518/2079-701X-2015-4-46-51
Abstract
Chronic heart failure (CHF) today is a heart condition with the least favourable prognosis. Over the past 10-15 years, in addition to strong rationale supporting the effectiveness of angiotensin-converting enzyme inhibitors (ACEI), results of use were obtained for angiotensin receptor blockers (ARB) and beta-blockers (BB), as well as new pharmacotherapies, such as mineralocorticoid receptor antagonists (MCRA), sinoatrial node activity inhibitors, and non-pharmacological interventions - implantable cardioverter-defibrillators and cardiac resynchronization therapy. The recent clinical guidelines for diagnosis and treatment of heart failure provide different classes of recommendation and levels of evidence for the mentioned approaches. One of the most significant changes in CHF pharmacotherapy is supplementation of ACEI and BB with MCRA as the primary treatment for patients with systolic heart failure (class I recommendation, A level of evidence). In this article, we would like to focus on the key aspects of using MCRA in patients with CHF.
About the Authors
I. V. Zhirov
the Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Research and Production Complex, Russia’s Ministry of Health
Russian Federation
Russian Federation
Y. F. Osmolovskaya
the Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Research and Production Complex, Russia’s Ministry of Health
Russian Federation
Russian Federation
S. N. Tereschenko
the Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Research and Production Complex, Russia’s Ministry of Health
Russian Federation
Russian Federation
References
1. Диагностика и лечение больных острым инфарктом миокарда с подъемом ST электрокардиограммы. Клинические рекомендации. Неотложная кардиология, 2014, 1: 42-62.
2. Мареев В.Ю., Скворцов А.А. Блокада эффектов альдостерона у больных сердечной недостаточностью: современный взгляд на проблему - эплеренон (часть II). Сердечная Недостаточность, 2011, 12 (4 (66)): 222-227,
3. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Сердечная Недостаточность, 2013, 14 (7 (81)).
4. Терещенко С.Н., Жиров И.В. Хроническая сердечная недостаточность. В кн.: Руководство по кардиологии. Под ред. Е.И. Чазова. М.: Практика, 2014. Т. 4. С. 192-291.
5. Терещенко С.Н., Жиров И.В., Осмоловская Ю.Ф. Антагонисты минералокортикоидных рецепторов в лечении больных с сердечной недостаточностью после инфаркта миокарда с хронической сердечной недостаточностью. Терапевтический архив, 2013, 85 (12): 137-144.
6. Федеральные клинические рекомендации по диагностике и лечению хронической и острой сердечной недостаточности. Евразийский кардиологический журнал, 2014, 2: 4-38.
7. ACCF/AHA Guideline for the management of heart failure. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2013, 128: e240-e327.
8. ACCF/AHA Guideline for the management of ST-elevation myocardial infarction. A report of the American College of Cardiology Foundation/American Heart Association. Circulation, 2013, 127: e362-e425.
9. Arriza JL, Weinberger C, Cerelli G et al. Cloning of human mineralocorticoid receptor comple-mentory DNA: structural and functional kinship with the glucocorticoid receptor. Science, 1987, 237 (4812): 268-275.
10. Arriza JL, Weinberger C, Cerelli G et al. Cloning of human mineralocorticoid receptor comple-mentory DNA: structural and functional kinship with the glucocorticoid receptor. Science, 1987, 237 (4812): 268-275.
11. Cook CS, Berry LM, Kim DH et al. Involvement of CYP3A in the metabolism of eplerenone in humans and dogs: differential metabolism by CYP3A4 and CYP3A5. Drug Metab Dispos., 2002, 30 (12): 1344-1351.
12. Degasparo M, Joss U, Ramjoue, et al. Three new epoxy-spironolactone derivates: characterization in vivo and in vitro. J Pharmacol Exp Ther, 1987, 240: 650-6.
13. Delyani J, Myles K, Funder J, et al. Eplerenone (SC 66110), a highly selective aldosteron antagonist. Am J Hypertens, 1998, 11: 94A.
14. Desai AS, Lewis EF, Li R, et al. Rationale and design of the treatment of preserved cardiac function heart failure with an aldosterone antagonist trial: a randomized, controlled study of spironolactone in patients with symptomatic heart failure and preserved ejection fraction. Am Heart J., 2011, 162(6): 966-972. e910.
15. Deswal A, Richardson P Bozkurt B, Mann DL. Results of the Randomized Aldosterone Antagonism in Heart Failure with Preserved Ejection Fraction trial (RAAM-PEF). J Card Fail., 2011, 17(8): 634-642.
16. Edelmann FWR, Schmidt AG, et al. Effect of spironolactone on diastolic function and exercise capacity in patients with heart failure with preserved ejection fraction: The Aldo-DHF randomized controlled trial. JAMA, 2013, 309(8): 781-791.
17. Edwards NC, Ferro CJ, Kirkwood H, et al. Effect of spironolactone on left ventricular systolic and diastolic function in patients with early stage chronic kidney disease. Am J Cardiol., 2010, 106(10): 1505-1511.
18. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European Heart Journal, 2012, 33: 1787-1847.
19. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal, 2011, 32: 2999-3054.
20. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal, 2012, 33: 2569-2619.
21. Montalescot G, Pitt B, Lopez de Sa E et al. Early eplerenone treatment in patients with acute ST-elevation myocardial infarction without heart failure: The Randomized Double-Blind Reminder Study. European Heart Journal, 2014; DOI: 10.1093/eurheartj/ehu164.
22. J. Guichard, Donald Clark II, D. A Calhoun et al. Aldosterone receptor antagonists: current perspectives and therapies. Vascular Health and Risk Management, 2013, 9: 321-331.
23. Lee AF, MacFadyen RJ, Struthers AD. Neuro-hormonal reactivationin heart failure patients on chronic ACE inhibitor therapy: a longitudinal study. Eur J Heart Fail., 1999, 1(4): 401-406.
24. Mak GJ, Ledwidge MT, Watson CJ, et al. Natural history of markers of collagen turnover in patients with early diastolic dysfunction and impact of eplerenone. J Am Coll Cardiol., 2009, 54(18): 1674-1682.
25. McMachon E. Recent studies with eplerenone, a novel selective aldosterone receptor antagonist. Current Opinion in Pharmacology, 2001, 1: 190-6.
26. Mottram PM, Haluska B, Leano R, Cowley D, Stowasser M, Marwick TH. Effect of aldosterone antagonism on myocardial dysfunction in hypertensive patients with diastolic heart failure. Circulation, 2004, 110(5): 558-565.
27. Muller J. Regulation of aldosterone biosynthesis: physiological and clinical aspects. Monographs on Endocrinology. 2nd ed. N.Y.: Springer-Verlag, 1988.
28. Muller J. Spironolactone in the management of congestive heart failure: a rewiew. Clin Ther., 1986, 9(1): 63-76.
29. Pitt B, Remme W, Zannad F, et al. Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction. N Engl J Med, 2003, 348: 1309-21
30. Pitt B, Roniker B. Eplerenone, a novel selective aldosteron receptor antagonist (SARA): dose -finding study in patients with heart failure. J Am Coll Cardiol., 1999, 33: 188A-9A.
31. Pitt B, Zannand F, Remme W, et al. The effect of spircnclactone on morbidity and mortality in patients with severe heart failure. N Engl J Med, 1999, 341: 709-17.
32. Sadee W, Dagcioglu M, Schroder R. Pharmaco-kinetics of spironolactone, canrenone and can-renoate-K in humans. J Pharmacol Exp Ther., 1973, 185(3): 686-695.
33. Sato A, Saruta T. Aldosterone escape during angi-otensin-converting enzyme inhibitor therapy in essential hypertensive patients with left ventricular hypertrophy. J Int Med Res., 2001, 29 (1): 13-21.
34. Smith AG. Spironolactone in the long-term management of patients with congestive heart failure. Curr Med Res Opin., 1980, 7(2): 131-136.
35. Swedberg K, Zannad F, McMurray JJ et al. Eplerenone and atrial fibrillation in mild systolic heart failure: results from the EMPHASIS-Hf (Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure) study. J Am Coll Cardiol., 2012, May 1, 59(18): 1598-603.
36. Urata H, Healy BH, Stewart R et al. Angiotensin II forming pathways in normal and failing human hearts. Circ Res., 1990, 66(4): 883-390.
37. Weber KT, Villarreal D. Aldosterone, and antial-dosterone therapy in congestive heart failure. Am J Cardiol, 1993, 71 (Suppl. A): 3A-11A.
38. Yasky J, Ledesma GA, Tutera A, Collia LF. A fixed-dose combination of furosemide and spironolac-tone in digitalized congestive heart failure patients. Pharmatherapeutica, 1986, 4(8): 480-485.
39. Zannad F, McMurray JJV, Drexler H et al. Rationale and design of the Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure (EMPHASIS-HF). Eur J Heart Fail., 2010,12 (6):617-622.
40. Zannad F., McMurray JJV, Krum H. et al. Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms. N Engl J Med, 2011, 364: 11-21.
Review
For citations:
Zhirov IV, Osmolovskaya YF, Tereschenko SN. In the wake of the latest clinical guidelines - mineralocorticoid receptor antagonists in the treatment of chronic heart failure. Meditsinskiy sovet = Medical Council. 2015;(4):46-51. (In Russ.) https://doi.org/10.21518/2079-701X-2015-4-46-51
Views:
540
Email this article 