Abstract：
Heart failure (HF) is a prevalent clinical syndrome characterized by significant morbidity and is often precipitated by impaired left ventricular myocardial function. The condition can be categorized into two primary forms based on the ejection fraction (EF): Heart failure with preserved ejection fraction (HFpEF) and Heart failure with reduced ejection fraction (HFrEF). Evidence-based treatments for HF have been instrumental in reducing morbidity and mortality, particularly in patients with HFrEF. Mineralocorticoid receptor antagonists (MRAs) represent a cornerstone in the pharmacological management of HF, with a strong indication for use in HFrEF. Notably, pharmacological nuances exist among MRAs, which may influence therapeutic decision-making for individual patients. Moreover, MRAs have been shown to enhance heart rate variability and improve cardiac sympathetic nervous system function in HF patients. Spironolactone, an MRA, has been a pivotal agent in the clinical management of HFrEF since its introduction. However, its use has been tempered by certain side effects, including gynecomastia and hyperkalemia, leading to considerable discontinuation rates among patients. To address these challenges, numerous randomized clinical trials (RCTs) have been conducted to assess the efficacy and safety profiles of alternative steroidal and non-steroidal MRAs. Eplerenone, a steroidal MRA introduced subsequent to spironolactone, has demonstrated efficacy with a more favorable side effect profile.
摘要：
心力衰竭（HF）是一种普遍的临床综合征，其特征是发病率高，通常由左心室心肌功能受损引起。根据射血分数（EF），可以将病情分为两种主要形式：射血分数保留的心力衰竭（HFpEF）和射血分数降低的心力衰竭（HFrEF）。HF的循证治疗在降低发病率和死亡率方面发挥了重要作用。特别是在HFrEF患者中。盐皮质激素受体拮抗剂（MRA）是HF药理学治疗的基石，具有在HFrEF中使用的强烈适应症。值得注意的是,MRA之间存在药理学细微差别，这可能会影响个体患者的治疗决策。此外，已显示MRA可增强HF患者的心率变异性并改善心脏交感神经系统功能。螺内酯,MRA,自HFrEF推出以来，一直是HFrEF临床管理的关键药物。然而,它的使用受到了某些副作用的影响，包括男性乳房发育症和高钾血症，导致患者中相当多的停药率。为了应对这些挑战，已经进行了大量随机临床试验(RCT),以评估替代甾体和非甾体MRA的疗效和安全性.Eplerenone,在螺内酯之后引入的甾体MRA，具有更有利的副作用的功效。
