Tag: Mineralocorticoid receptor antagonists

In the United States, primary aldosteronism is a more common cause of hypertension than previously thought, affecting up to 22% of people with severe high blood pressure. Contrary to what some might assume, the key question, 'Does aldosterone decrease afterload?' has a clear answer: no, it increases it.

First-generation mineralocorticoid receptor antagonists (MRAs) like spironolactone have been in use since the 1960s, predating the approval of the non-steroidal finerenone in 2021. The core **difference between finerenone and spironolactone** lies in their chemical structure, which leads to varying selectivity for the mineralocorticoid receptor, tissue distribution, side effect profiles, and specific clinical applications.

According to the 2022 guidelines from the American Heart Association and other major cardiology societies, patients with heart failure with reduced ejection fraction (HFrEF) should receive a combination of four core therapies. These four medication classes are now considered the foundational pillars of treatment for many heart failure patients, significantly reducing hospitalizations and improving survival.