The Role of the Mineralocorticoid Receptor and Mineralocorticoid Receptor-Directed Therapies in Heart Failure

Morag J. Young, Monica Kanki, Nikshay Karthigan, Penny Konstandopoulos

Research output: Contribution to journalReview ArticleResearchpeer-review

8 Citations (Scopus)

Abstract

Mineralocorticoid receptor (MR) antagonists (MRA), also referred to as aldosterone blockers, are now well-recognized for their clinical benefit in patients who have heart failure (HF) with reduced ejection fraction (HFrEF). Recent studies have also shown MRA can improve outcomes in patients with HFpEF, where the ejection fraction is preserved but left ventricular filling is reduced. While the MR is a steroid hormone receptor best known for antinatriuretic actions on electrolyte homeostasis in the distal nephron, it is now established that the MR has many physiological and pathophysiological roles in the heart, vasculature, and other nonepithelial tissue types. It is the impact of MR activation on these tissues that underpins the use of MRA in cardiovascular disease, in particular HF. This mini-review will discuss the origins and the development of MRA and highlight how their use has evolved from the "potassium-sparing diuretics"spironolactone and canrenone over 60 years ago, to the more receptor-selective eplerenone and most recently the emergence of new nonsteroidal receptor antagonists esaxerenone and finerenone.

Original languageEnglish
Article numberbqab105
Number of pages15
JournalEndocrinology
Volume162
Issue number11
DOIs
Publication statusPublished - 1 Nov 2021
Externally publishedYes

Keywords

  • aldosterone
  • eplerenone
  • esaxerenone
  • finerenone
  • heart failure
  • mineralocorticoid receptor
  • mineralocorticoid receptor antagonist
  • MRA
  • non-steroidal
  • spironolactone

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