THE USE OF SPIRONOLACTONE IN THE TREATMENT OF HEART FAILURE

Abstract

Spironolactone, a non-selective mineralocorticoid receptor antagonist, plays a well-established role in the treatment of heart failure, especially in cases with reduced ejection fraction (HFrEF). Its aldosterone-blocking action contributes to beneficial effects such as promoting natriuresis, preserving serum potassium, reducing myocardial fibrosis, and reversing cardiac remodeling. The aim of this paper is to highlight the effects and benefits of this medication in heart failure. A literature review was conducted in the main medical databases using the descriptors "spironolactone," "treatment," and "heart failure," utilizing the Boolean operator "AND." All articles published between 2020 and 2025 were included in the primary analysis. Robust evidence, such as the RALES and EMPHASIS-HF studies, demonstrated significant reductions in mortality and hospitalizations, as well as improvements in patients' quality of life and functional capacity. Despite these benefits, the use of spironolactone requires strict monitoring due to the risk of hyperkalemia and adverse effects such as gynecomastia. In patients with heart failure with preserved ejection fraction (HFpEF), results are less consistent, requiring individualized assessment. International guidelines recommend its use as part of the standard treatment for HFrEF, reinforcing its importance in the evidence-based therapeutic approach to heart failure.