Three ages of spironolactone. Evolution of views on spironolactone capabilities in the treatment of patients with heart failure.
https://doi.org/10.18087/cardio.2022.7.n2233
Abstract
The article describes the history of the discovery of aldosterone and the creation of its antagonist, spironolactone. The effects of aldosterone associated with the stimulation of two types of receptors. Long-term effect (nuclear or genomic) and fast - term (membrane). They are manifested not only by the influence on the water-salt metabolism and the volume of extracellular fluid, but also in the regulation of vascular tone and elasticity of the vascular wall and, most interestingly, the effect on cardiac remodeling. Early after its development Spironolactone was considered as a medicine for water-salt metabolism regulation, diuresis and normalization of blood pressure. In the following period, Spironolactone embraced a new area - systolic heart failure. The drug was considered not only to enhance safe diuresis, but also to eliminate the phenomenon of escape of the antialdosterone effect angiotensin-converting enzyme inhibitors. The change in the paradigm of heart failure towards the prevailing changes in her diastolic phenotype, which is based on excessive diffuse myocardial fibrosis, changed role of spironolactone in the treatment of heart failure. Currently, it is considered as an independent drug, due to its powerful antifibrotic effect, blocking which controls the whole complex of endo- and paracrine effects of aldosterone.
Supporting agencies: No conflict of interest is reported.
About the Author
F. T. Ageev
Federal State Budgetary Institution NATIONAL MEDICAL RESEARCH CENTRE OF CARDIOLOGY NAMED AFTER ACADEMICIAN E.I.CHAZOV. Of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
M.D., Prof. , Chief Researcher
Moscow, Russia
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Ageev F.T. Three ages of spironolactone. Evolution of views on spironolactone capabilities in the treatment of patients with heart failure. Kardiologiia. 2022;62(7):3-11. https://doi.org/10.18087/cardio.2022.7.n2233
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