What are the potential benefits and harms of using mineralocorticoid receptor antagonists (MRAs) for treating heart failure?
The use of mineralocorticoid receptor antagonists (MRAs) led to a clinically important reduction in mortality and hospitalisations, and possibly an improvement in NYHA class. However, MRAs also led to a clinically important increase in the number of patients experiencing hyperkalaemia. There was also some evidence of worsening renal function and an increase in hypotension in patients using MRAs, though this evidence was mixed and mostly suggested a difference of insufficient magnitude to be clinically important. The use of spironolactone was associated with a clinically important increase in gynaecomastia. This was not the case for eplerenone, where the very low quality evidence suggested that there was no clinically important difference. The committee agreed that there was likely to be no clinically important difference between the eplerenone and placebo group. Overall, the beneficial effects of MRAs on mortality and hospitalisation outweighed the risk of hyperkalaemia and the possible impact on renal function.