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Mineralocorticoid Receptor Antagonists Unlikely to Induce Hypotension in HFrEF

Patients with heart failure with reduced ejection fraction (HFrEF) can be treated with mineralocorticoid receptor antagonists (MRAs) and are unlikely to develop hypotension as a result, an analysis of two large randomized trials reveals.

In both trials, the starting dose of the study drug was 25 mg once daily. Spironolactone could be increased to 50 mg after eight weeks, whereas eplerenone was increased to 50 mg daily after four weeks, absent hyperkalemia or other intolerance.

There were 702 patients with a baseline systolic blood pressure (SBP) of 105 mmHg or less; 870 with an SBP between 105 to 115; 960 with an SBP >115 to 125; 823 with an SBP of >125 to 135; and 1,041 with an SBP >135.

Hypotension was infrequent and not more common with an MRA than with placebo overall (4.6% vs. 3.9%) or in any SBP category.