Aldosterone Blockade and Heart Failure

Abstract

In the fall of 1999, a multicenter, randomized trial examining the effect of spironolactone on morbidity and mortality among patients with severe heart failure was published in the Journal.¹ The Randomized Aldactone Evaluation Study (RALES) proved that antagonism of aldosterone had an important role in the management of heart failure, even in patients taking angiotensin-converting–enzyme (ACE) inhibitors. In addition to reducing mortality by 30 percent, small doses of spironolactone resulted in an improvement in ventricular function and enhanced exercise tolerance.² The rates of death from progressive heart failure and sudden death from cardiac causes were both diminished by an . . .