Journal ArticleDOI
Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction
Bertram Pitt,Willem J. Remme,Faiez Zannad,James D. Neaton,Felipe Martinez,Barbara Roniker,Richard Bittman,Steve Hurley,Jay H. Kleiman,Marjorie Gatlin +9 more
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TLDR
The addition of eplerenone to optimal medical therapy reduces morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure.Abstract:
background Aldosterone blockade reduces mortality and morbidity among patients with severe heart failure. We conducted a double-blind, placebo-controlled study evaluating the effect of eplerenone, a selective aldosterone blocker, on morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure. methods Patients were randomly assigned to eplerenone (25 mg per day initially, titrated to a maximum of 50 mg per day; 3313 patients) or placebo (3319 patients) in addition to optimal medical therapy. The study continued until 1012 deaths occurred. The primary end points were death from any cause and death from cardiovascular causes or hospitalization for heart failure, acute myocardial infarction, stroke, or ventricular arrhythmia. results During a mean follow-up of 16 months, there were 478 deaths in the eplerenone group and 554 deaths in the placebo group (relative risk, 0.85; 95 percent confidence interval, 0.75 to 0.96; P=0.008). Of these deaths, 407 in the eplerenone group and 483 in the placebo group were attributed to cardiovascular causes (relative risk, 0.83; 95 percent confidence interval, 0.72 to 0.94; P = 0.005). The rate of the other primary end point, death from cardiovascular causes or hospitalization for cardiovascular events, was reduced by eplerenone (relative risk, 0.87; 95 percent confidence interval, 0.79 to 0.95; P=0.002), as was the secondary end point of death from any cause or any hospitalization (relative risk, 0.92; 95 percent confidence interval, 0.86 to 0.98; P=0.02). There was also a reduction in the rate of sudden death from cardiac causes (relative risk, 0.79; 95 percent confidence interval, 0.64 to 0.97; P=0.03). The rate of serious hyperkalemia was 5.5 percent in the eplerenone group and 3.9 percent in the placebo group (P = 0.002), whereas the rate of hypokalemia was 8.4 percent in the eplerenone group and 13.1 percent in the placebo group (P<0.001). conclusions The addition of eplerenone to optimal medical therapy reduces morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure.read more
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Journal ArticleDOI
Antiarrhythmic and nonantiarrhythmic drugs for sudden cardiac death prevention.
TL;DR: Drugs acting on the renin-angiotensin-aldosterone system, fish oil, and statins can reduce the likelihood of future ventricular tachycardia/ventricular fibrillation in patients with coronary artery disease or congestive heart failure and their benefits should outweigh risks.
Journal ArticleDOI
Eplerenone attenuates pathological pulmonary vascular rather than right ventricular remodeling in pulmonary arterial hypertension.
Mario Boehm,Nadine Arnold,Adam Braithwaite,Josephine A. Pickworth,Changwu Lu,Tatyana Novoyatleva,David G. Kiely,Friedrich Grimminger,Hossein Ardeschir Ghofrani,Norbert Weissmann,Werner Seeger,Allan Lawrie,Ralph T. Schermuly,Baktybek Kojonazarov +13 more
TL;DR: It is indicated that aldosterone antagonism with Eplerenone attenuates pulmonary vascular rather than RV remodeling in PAH and significantly lowered systemic blood pressure.
Journal ArticleDOI
Regression of left ventricular hypertrophy in patients with primary aldosteronism/low-renin hypertension on low-dose spironolactone
Yaacov Ori,Avry Chagnac,Avry Chagnac,Asher Korzets,Asher Korzets,Boris Zingerman,Boris Zingerman,Michal Herman-Edelstein,Michal Herman-Edelstein,Michael Bergman,Michael Bergman,Uzi Gafter,Uzi Gafter,Hertzel Salman,Hertzel Salman +14 more
TL;DR: In patients with PA/low-renin hypertension, long-term regression of LVH may be achieved with low-dose MRB with results that enable the reduction of other antihypertensive medications.
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Guía de práctica clínica de la ESC para el manejo del infarto agudo de miocardio en pacientes con elevación del segmento ST
Gabriel Steg,Stefan James,Dan Atar,Luigi P. Badano,Carina Blomström Lundqvist,Michael A. Borger,Carlo Di Mario,Kenneth Dickstein,Gregory Ducrocq,Francisco Fernández-Avilés,Anthony H. Gershlick,Pantaleo Giannuzzi,Sigrun Halvorsen,Kurt Huber,Peter Jüni,Adnan Kastrati,Juhani Knuuti,Mattie J. Lenzen,Kenneth W. Mahaffey,Marco Valgimigli,Arnoud W van 't Hof,Petr Widimsky,Doron Zahger,Jeroen J. Bax,Helmut Baumgartner,Claudio Ceconi,Veronica Dean,Christi Deaton,Robert Fagard,Christian Funck-Brentano,David Hasdai,Arno W. Hoes,Paulus Kirchhof,Philippe Kolh,Theresa McDonagh,Cyril Moulin,Bogdan A. Popescu,Zeljko Reiner,Udo Sechtem,Per Anton Sirnes,Michal Tendera,Adam Torbicki,Alec Vahanian,Stephan Windecker,Felicity Astin,Karin Astrom-Olsson,Andrzej Budaj,Peter Clemmensen,Jean-Philippe Collet,Keith A.A. Fox,Ahmet Fuat,Olivija Gustiene,Christian W. Hamm,Petr Kala,Patrizio Lancellotti,Aldo P. Maggioni,Béla Merkely,Franz-Josef Neumann,Massimo F. Piepoli,Frans Van de Werf,Freek W.A. Verheugt,Lars Wallentin +61 more
TL;DR: Autores/Miembros del Grupo de Trabajo: Ph.D.s, MSc, Diputados Unidos, República Checa, Petr Widimsky.
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A review of the renal and neurohormonal effects of B-type natriuretic peptide.
TL;DR: Clinical trials demonstrate that nesiritide quickly reduces clinical symptoms and improves mortality in patients with acute CHF, and blunts adverse neurohormones, including renin, aldosterone, norepinephrine, and endothelin-1.
References
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The effect of spironolactone on morbidity and mortality in patients with severe heart failure
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