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Aldosterone Antagonists in Patients With Heart Failure

Abdallah Fayssoil, MD
JAMA. 2010;303(9):833-835. doi:10.1001/jama.2010.185
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To the Editor: Dr Albert and colleagues1 studied the prescription of aldosterone antagonists for patients with heart failure (HF). Among the patients studied, 46% had nonischemic HF. It would be helpful to know whether the strength of the associations with aldosterone antagonist use found in the study differed between the nonischemic group and the ischemic group.

Because the use of aldosterone antagonists together with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or β-blockers can lead to hypotensive episodes,2 I would like to know if the authors assessed whether this reaction could explain interruption in aldosterone antagonists use. Also, because new-onset arrhythmia may be influenced by the renin-angiotensin-aldosterone system,3 I would like to know whether the authors assessed correlation between onset of arrhythmia and aldosterone antagonist use.

AUTHOR INFORMATION

Financial Disclosures: None reported.

REFERENCES

Albert NM, Yancy CW, Liang L,  et al.  Use of aldosterone antagonists in heart failure.  JAMA. 2009;302(15):1658-1665
PubMedCrossRef
Mak G, Murphy NF, Ali A,  et al.  Multiple neurohumoral modulating agents in systolic dysfunction heart failure: are we lowering blood pressure too much?  J Card Fail. 2008;14(7):555-560
PubMedCrossRef
Makkar KM, Sanoski CA, Spinler SA. Role of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and aldosterone antagonists in the prevention of atrial and ventricular arrhythmias.  Pharmacotherapy. 2009;29(1):31-48
PubMedCrossRef

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Albert NM, Yancy CW, Liang L,  et al.  Use of aldosterone antagonists in heart failure.  JAMA. 2009;302(15):1658-1665
PubMedCrossRef
Mak G, Murphy NF, Ali A,  et al.  Multiple neurohumoral modulating agents in systolic dysfunction heart failure: are we lowering blood pressure too much?  J Card Fail. 2008;14(7):555-560
PubMedCrossRef
Makkar KM, Sanoski CA, Spinler SA. Role of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and aldosterone antagonists in the prevention of atrial and ventricular arrhythmias.  Pharmacotherapy. 2009;29(1):31-48
PubMedCrossRef
March 3, 2010
Jalal K. Ghali, MD
JAMA. 2010;303(9):833-835.
March 3, 2010
Nancy M. Albert, PhD, RN; Gregg C. Fonarow, MD; Adrian F. Hernandez, MD
JAMA. 2010;303(9):833-835.
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To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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