EFFICACY OF MINERALOCORTICOID RECEPTOR ANTAGONISTS IN THE TREATMENT OF HEART FAILURE WITH PRESERVED EJECTION FRACTION

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a complex and growing clinical condition for which effective therapeutic options remain limited. Mineralocorticoid receptor antagonists (MRAs), such as spironolactone and eplerenone, have demonstrated significant benefits in heart failure with reduced ejection fraction (HFrEF), but their efficacy in HFpEF is not yet fully established. This integrative review assessed the efficacy of MRAs in the treatment of patients with HFpEF, analyzing data from randomized controlled trials, observational studies, and meta-analyses. The results revealed that although MRAs can improve diastolic function and reduce ventricular stiffness, the impact on mortality and hospitalizations was not consistently positive. Adverse effects, such as hyperkalemia and renal failure, were also frequently observed, suggesting the need for careful monitoring and dose adjustments. Current evidence suggests that MRAs may benefit specific subgroups of patients, but universal application of these agents should be approached with caution. Future research should focus on identifying clinical features and biomarkers that can predict response to MRA treatment to optimize the therapeutic approach in HFpEF.