spironolactone on the heart

[Lany]

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spironolactone dec. mortality in class III and IV CHF pxts.

in uworld "spironolactone in HF patients are more than likely secondary to inhibition of the neurohormonal effects of aldosterone leading to decreased ventricular remodeling and cardiac fibrosis". Can anyone explain it beyond this? what neurohormonal effect? Is it because spironolactone inhibits aldosterone working on the heart compared to other diuretics which decreases aldosterone altogether?

 

[45408]

Ha, I think I had this question today or yesterday. Other diuretics (ACE inhibitors) that decrease aldosterone can eventually be overridden, and aldosterone then continues to exert its effects. If you directly block its receptor (spironolactone, eplerenone) in addition to blocking the renin-ang-aldo system (an ACE-i), then you can further prolong longevity.

 

[osli]

Yeah, I think that's often referred to as the "aldosterone escape" of ACEi's and ARB's. Spironolactone does not suffer from aldosterone escape for the reason TheProwler stated above.