Mineralocorticoid Receptor Antagonist and Its Combinations in Heart Failure

Mineralocorticoid receptor antagonists (MRAs) are strongly recommended by various guidelines for the management of patients with heart failure. Present and emerging clinical evidence also supports the beneficial role of MRAs in lowering the risk of heart failure-associated hospitalization and mortality. Loop diuretics play a crucial role in the management of edema associated with heart failure; however, their use has been associated with electrolyte abnormalities, activation of the renin-angiotensin-aldosterone and sympathetic systems, and diuretic resistance. Combined use of loop diuretics along with MRAs can help to overcome the diuretic resistance and improve the efficacy and safety of loop diuretics. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are another class of drugs that have shown significant benefits in patients with heart failure and are guideline-recommended for use in these patients. Combination therapy of SGLT2 inhibitors along with MRAs can improve various clinical outcomes in heart failure patients and reduce the risk of hyperkalemia, commonly associated with MRA therapy. Combination therapies can be potential opportunities to improve clinical outcomes and patient adherence in the management of patients with heart failure.