Aplicaciones y proyecciones de los antagonistas del receptor de mineralocorticoides en el tratamiento de patologías cardiovasculares

Resumen

In recent years, much attention has focused on the role of aldosterone and mineralocorticoid receptors (MRs) in the pathophysiology of hypertension and several cardiovascular diseases. It has been shown that patients with primary aldosteronism, in which angiotensin II levels are low, have a higher incidence of cardiovascular complications than do patients with essential hypertension. The Randomized Aldactone Evaluation Study (RALES) demonstrated that adding a non-specific MR antagonist, spironolactone, to a standard therapy that included angiotensin-converting enzyme (ACE) inhibitors, loop diuretics, and digoxin, significantly reduced morbidity and mortality in patients with moderate to severe heart failure. Similarly, the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS)  revealed that the addition of a selective MR antagonist (ARM), eplerenone, to an optimal medical therapy reduces morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure. These data suggest that aldosterone induces cardiac damage through activation of MRs and support the notion that MR blockade has beneficial effects on aldosterone-dependent cardiac injury through mechanisms that cannot be simply explained by hemodynamic changes. Although, ARMsseems to be highly useful in patients with heart failure, the risk of hyperkalemia should not be overlooked,particularly in patients who do not meet the inclusion criteria of the RALES study.

 In this review we will discussed recent findings related to the roles of aldosterone and MRs in the pathogenesis of cardiovascular tissue injury, with special emphasis on the cardioprotectiveproperties of MR antagonists.