Mineralocorticoid Receptor Antagonists Treatment in Resistant Hypertension and HFpEF: Evidence and Courage

Heart failure is a complex syndrome and associated with a major health-economic burden due the high hospital readmission rate. During the last decade heart failure management has been more focused on heart failure with preserved ejection fraction (HFpEF).¹ There are some limitations in the classification and recognizing the different phenotypes within HFpEF. Consequently, this may lead to more tailored therapy for heart failure. Hypertension, diabetes beyond age and gender play an important role in the development of HFpEF.² Resistant hypertension increases the risk for development of HFpEF and may aggravate the HFpEF process. It is evident that resistant hypertension needs to be treated appropriately.^3,4 A few studies like ASCOT and PATHWAY-2 have shown that mineralocorticoid receptor antagonists (MRA), especially spironolactone are very effective in blood pressure lowering.^5,6 There is still therapeutic inertia in the treatment of resistant hypertension,⁷ which lead unfortunately to worsening of the heart failure condition.

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