New aldosteron receptor inhibitors in heart failure

This report summarizes the new therapeutic approaches in post-ischaemic heart failure given the important sanitary and socioeconomic impact resulting from the clinical management of this syndrome. Ventricular remodeling, causing changes to left ventricular anatomy and function, is the major cause of heart dysfunction. The physio-pathological role of the renin-angiotensin-aldosterone system has emerged from experimental studies and has been confirmed by the efficacy of ACE-inhibition. Although treatment with spironolactone (a non selective aldosterone antagonist) significantly reduces both the hospitalization and the mortality of NYHA III patients, this compound has important side effects. In this review we examine the efficacy of eplerenone, a new aldosterone receptor antagonist, with a more selective activity with respect to spironolactone. Several studies versus placebo have demonstrated that this molecule, alone or in combination with anti-hypertensive drugs, is very effective in left ventricular hypertrophy and in post-ischaemic heart failure treatment. In particular, we will consider the EPHESUS as the most important study both for the size of patient group and for the experimental plan. Finally, as regards the culture and experience of single physicians, a simple flow chart of the therapy of post-ischaemic heart failure is proposed.