***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Aims To evaluate oral doses of the non-steroidal mineralocorticoid receptor antagonist finerenone given for 90 days in patients with worsening heart failure and reduced ejection fraction and chronic kidney disease and /or diabetes mellitus . Methods and results Miner Alocorticoid Receptor antagonist Tolerability Study -Heart Failure ( ARTS-HF ) was a r and omized , double-blind , phase 2b multicentre study ( Clinical Trials.gov : NCT01807221 ) . Of 1286 screened patients , 1066 were r and omized . Patients received oral , once-daily finerenone ( 2.5 , 5 , 7.5 , 10 , or 15 mg , uptitrated to 5 , 10 , 15 , 20 , or 20 mg , respectively , on Day 30 ) or eplerenone ( 25 mg every other day , increased to 25 mg once daily on Day 30 , and to 50 mg once daily on Day 60 ) for 90 days . The primary endpoint was the percentage of individuals with a decrease of > 30 % in plasma N-terminal pro-B-type natriuretic peptide ( NT-proBNP ) from baseline to Day 90 . A key exploratory endpoint was a composite clinical endpoint of death from any cause , cardiovascular hospitalizations , or emergency presentation for worsening HF until Day 90 . Mean age ranged from 69.2 to 72.5 years in different treatment groups ( st and ard deviation 9.7–10.6 years ) . Decreases in NT-proBNP of > 30 % from baseline occurred in 37.2 % of patients in the eplerenone group and 30.9 , 32.5 , 37.3 , 38.8 , and 34.2 % in the 2.5→5 , 5→10 , 7.5→15 , 10→20 , and 15→20 mg finerenone groups , respectively ( P = 0.42–0.88 ) . Except for the 2.5→5 mg finerenone group , the composite clinical endpoint occurred numerically less frequently in finerenone-treated patients compared with eplerenone ; this difference reached nominal statistical significance in the 10→20 mg group ( hazard ratio 0.56 , 95 % confidence interval , CI , 0.35 ; 0.90 ; nominal P = 0.02 ) , despite the fact that this phase 2 study was not design ed to detect statistical significant differences . A potassium level increase to ≥5.6 mmol/L at any time point occurred in 4.3 % of patients , with a balanced distribution among all treatment groups . Conclusion Finerenone was well tolerated and induced a 30 % or greater decrease in NT-proBNP levels in a similar proportion of patients to eplerenone . The finding of reduced clinical events in the finerenone 10→20 mg group should be further explored in a large outcomes trial BACKGROUND Finerenone , a nonsteroidal mineralocorticoid receptor antagonist , was evaluated in Japanese patients with heart failure ( HF ) with reduced ejection fraction and chronic kidney disease and /or diabetes mellitus . METHODS AND RESULTS ARTS-HF Japan was a r and omized , double-blind , phase 2b study . Patients ( n=72 ) received oral , once-daily ( o.d . ) finerenone ( 2.5 , 5 , 7.5 , 10 or 15 mg , up-titrated to 5 , 10 , 15 , 20 , or 20 mg , respectively , on day 30 ) or eplerenone ( 25 mg every other day , increased to 25 mg o.d . on day 30 , and 50 mg on day 60 ) for 90 days . The primary endpoint was the proportion of individuals with a decrease of > 30 % in plasma NT-proBNP at day 90 . Safety endpoints included the incidence of hyperkalemia . Decreases in NT-proBNP occurred in 23.1 % of patients in the eplerenone group and 15.4 % , 23.1 % , 45.5 % , 27.3 % and 45.5 % in the 2.5→5 mg , 5→10 mg , 7.5→15 mg , 10→20 mg and 15→20 mg finerenone groups , respectively ( all P = NS ) . Mean changes in serum potassium levels were similar between groups . CONCLUSIONS Because of the small sample size , limited conclusions can be drawn . Considering the results of ARTS-HF and that finerenone was well tolerated in Japanese patients in ARTS-HF Japan , the safety and efficacy of finerenone should be further explored in a large outcomes trial including Japanese patients . ( Circ J 2016 ; 80 : 1113 - 1122 ) Aims Mineralocorticoid receptor antagonists ( MRAs ) improve outcomes in patients with heart failure and reduced left ventricular ejection fraction ( HFrEF ) , but their use is limited by hyperkalaemia and /or worsening renal function ( WRF ) . BAY 94 - 8862 is a highly selective and strongly potent non-steroidal MRA . We investigated its safety and tolerability in patients with HFrEF associated with mild or moderate chronic kidney disease ( CKD ) . Methods and results This r and omized , controlled , phase II trial consisted of two parts . In part A , the safety and tolerability of oral BAY 94 - 8862 [ 2.5 , 5 , or 10 mg once daily ( q.d . ) ] was assessed in 65 patients with HFrEF and mild CKD . In part B , BAY 94 - 8862 ( 2.5 , 5 , or 10 mg q.d . , or 5 mg twice daily ) was compared with placebo and open-label spironolactone ( 25 or 50 mg/day ) in 392 patients with HFrEF and moderate CKD . BAY 94 - 8862 was associated with significantly smaller mean increases in serum potassium concentration than spironolactone ( 0.04–0.30 and 0.45 mmol/L , respectively , P < 0.0001–0.0107 ) and lower incidences of hyperkalaemia ( 5.3 and 12.7 % , respectively , P = 0.048 ) and WRF . BAY 94 - 8862 decreased the levels of B-type natriuretic peptide ( BNP ) , amino-terminal proBNP , and albuminuria at least as much as spironolactone . Adverse events related to BAY 94 - 8862 were infrequent and mostly mild . Conclusion In patients with HFrEF and moderate CKD , BAY 94 - 8862 5–10 mg/day was at least as effective as spironolactone 25 or 50 mg/day in decreasing biomarkers of haemodynamic stress , but it was associated with lower incidences of hyperkalaemia and WRF Abstract Background Several studies demonstrated that mineralocorticoid receptor antagonists ( MRAs ) are able to prevent myocardial and vascular fibrosis , and left ventricular ( LV ) remodeling in patients with systolic chronic heart failure ( HF ) and mild symptoms .  Ventricular-arterial coupling ( VAC ) should be influenced by anti-fibrotic interventions . We have assessed the effects of spironolactone on VAC and its components , aortic elastance ( Ea ) and end-systolic LV elastance ( Ees ) , in patients with HF . Methods and results Changes from baseline in VAC were compared between 65 patients treated with spironolactone and 32 controls not receiving MRAs . All patients had HF , reduced LVEF with reduced LV ejection fraction ( LVEF ) and New York Heart Association ( NYHA ) functional class I – II symptoms , and underwent transthoracic echocardiography at baseline and after 6 months . VAC was estimated by the modified single-beat method as Ea/Ees . Parameters of LV function improved after 6 month treatment with spironolactone with an increase in the LVEF from 34 ± 8 to 39 ± 8 % ( p < 0.001 ) . Spironolactone  increased Ees from 1.32 ± 0.38 to 1.57 ± 0.42 mmHg/mL ( p < 0.001 ) and reduced VAC from 2.03 ± 0.59 to 1.66 ± 0.31 ( p < 0.001 ) , but did not affect Ea and V0 ( LV volume at end-systolic pressure of 0 mmHg ) . No change in any of these parameters occurred in the control group . Conclusions 6-month therapy with spironolactone  improved VAC mainly through its effect on Ees in patients with mild HF INTRODUCTION Spironolactone is increasingly being used in the treatment of heart failure . However , it has been associated with cases of hyperkalaemia . The common use of angiotensin-converting enzyme ( ACE ) inhibitors and angiotensin-2 receptor ( AT2 ) antagonists in heart failure increases the risk of hyperkalaemia . OBJECTIVE To identify the risk of spironolactone  withdrawal , hyperkalaemia and severe hyperkalaemia in patients prescribed spironolactone together with either an ACE inhibitor or an AT2 antagonist .  METHODS Retrospective identification and analysis of patients co-prescribed an ACE inhibitor or an AT2 antagonist with spironolactone . Patients ' records were linked to their biochemical results and the doses of spironolactone , ACE inhibitor and AT2 antagonists received by them . RESULTS We found that a higher proportion of patients in our cohort stopped taking spironolactone compared with the R and omised Aldactone Evaluation Study and a higher proportion developed hyperkalaemia , a predicted adverse effect of spironolactone combination with an ACE inhibitor or an AT2 antagonist .  Patients with diabetes mellitus and those with a haematocrit below 0.36 , were more likely to develop hyperkalaemia than those without these traits . CONCLUSIONS Spironolactone is a common cause of hyperkalaemia when used in combination with either an ACE inhibitor or an AT2 antagonist . This reinforces the need for care when extrapolating the results of clinical trials to daily clinical practice Background Eplerenone is cl aim ed to be a more selective blocker of the mineralocorticoid receptor than spironolactone being associated with fewer anti and rogenic side-effects . We compared the efficacy , safety and tolerability of eplerenone versus spironolactone in patients with hypertension associated with primary aldosteronism . Methods The study was multicentre , r and omized , double-blind , active-controlled , and parallel group design . Following a single-blind , placebo run-in period , patients were r and omized 1 : 1 to a 16-week double-blind , treatment period of spironolactone ( 75–225 mg once daily ) or eplerenone ( 100–300 mg once daily ) using a titration-to-effect design . To be r and omized , patients had to meet biochemical criteria for primary aldosteronism and have a seated DBP at least 90 mmHg and less than 120 mmHg and SBP less than 200 mmHg . The primary efficacy endpoint was the antihypertensive effect of eplerenone  versus  spironolactone  to establish noninferiority of eplerenone in the mean change from baseline in seated DBP . Results Changes from baseline in DBP were less on eplerenone ( −5.6 ± 1.3 SE mmHg ) than spironolactone ( −12.5 ± 1.3 SE mmHg ) [ difference , −6.9 mmHg ( −10.6 , −3.3 ) ; P < 0.001 ] . Although there were no significant differences between eplerenone and spironolactone in the overall incidence of adverse events , more patients r and omized to  spironolactone  developed  male gynaecomastia  ( 21.2 versus 4.5 % ; P = 0.033 ) and female mastodynia ( 21.1 versus 0.0 % ; P = 0.026 ) . Conclusion The antihypertensive effect of spironolactone was significantly greater than that of eplerenone in hypertension associated with primary aldosteronism BACKGROUND AND METHODS Aldosterone is important in the pathophysiology of heart failure . In a doubleblind study , we enrolled 1663 patients who had severe heart failure and a left ventricular ejection fraction of no more than 35 percent and who were being treated with an angiotensin-converting-enzyme inhibitor , a loop diuretic , and in most cases digoxin .  A total of 822 patients were r and omly assigned to receive 25 mg of spironolactone daily , and 841 to receive placebo . The primary end point was death from all causes . RESULTS The trial was discontinued early , after a mean follow-up period of 24 months , because an interim analysis determined that spironolactone was efficacious . There were 386 deaths in the placebo 
    Output:
    
Conclusions : Finerenone  reduced NT-proBNP level , urinary albumin/creatinine ratio ( UACR ) , and other biochemical indicators , in a dose-dependent manner .
In terms of anti-ventricular remodeling in patient with chronic heart failure , finerenone at 10 mg/d is as effective as 20 to 50 mg/d of steroidal MRAs .
However , finerenone is much safer to patients with chronic kidney disease