Aldosterone as a target in congestive heart failure

Based upon the results of the Randomized Aldactone Evaluation Study trial and accumulating evidence concerning the role of aldosterone and aldosterone receptor antagonism in various disease states, we anticipate that aldosterone receptor antagonists will become standard therapy, along with angiotensin-converting enzyme inhibitors and beta-adrenergic receptor blocking agents, in patients with heart failure caused by systolic left ventricular dysfunction. The use of these agents in other disease states that has implicated an activated rennin-angiotensin-aldosterone cascade, such as diastolic dysfunction, aging, and atherosclerosis remains to be tested. Until further data from well-designed, prospective, randomized trials are available, we would restrict the use of aldosterone receptor antagonists in patients with heart failure to those with severe or progressive heart failure that is caused by systolic left ventricular dysfunction in whom serum creatinine is less than or equal to2.0 mg/dL and serum potassium is <5.0 meq/L at baseline.