The role of selective blockers of mineralocorticoid receptors in the treatment of chronic heart failure

The negative role of secondary aldosteronism in CHF is known for a long time. For a long time, a high level of mineralocorticoid hormone aldosterone was associated with fluid retention in the body and stimulation of electrolyte imbalance with a delay in sodium and potassium loss. Therefore, from the middle of the 1960s on, for almost half a century, spironolactone in doses of 100-300 mg / day was successfully used in complex diuretic therapy of severe CHF, as a potassium-sparing diuretic [1]. A difficult period in the "life" of spironolactone occurred after the appearance in practice of ACE inhibitors (ACE inhibitors), which in the initial period of treatment reduce the synthesis of aldosterone in the body. Therefore, there were recommendations about the undesirable combination of ACE inhibitors and spironolactone in the treatment of CHF, tk. this could be fraught with the development of hyperkalemia and impaired renal function [3]. However, it was found that neither ACE inhibitors, nor APA, nor β-AB, nor the combination of ACE inhibitors with β-AB, and even the triple combination of ACE inhibitors + APA + β-AB can not block the synthesis of aldosterone for a long time [4,5]...