Pairing new medications could offer hope to heart disease patients

Cardiologist Bertram Pitt, MD, sees promise in combining two new classes of medication into a treatment regimen for patients with cardiovascular disease. Pitt will discuss the advantages of this treatment plan in his clinical plenary lecture at the American Physiological Society (APS) Aldosterone and ENaC in Health and Disease: The Kidney and Beyond Conference in Estes Park, Colo.

Currently, a primary course of treatment for patients with heart failure or resistant high blood pressure is a class of medications called steroidal mineralocorticoid receptor antagonists (s-MRA), chiefly spironolactone. S-MRAs work by blocking the body's reabsorption of sodium, leading to increased fluid excretion.

S-MRAs are effective at reducing heart failure-related mortality or hospitalization. The World Health Organization includes spironolactone on its List of Essential Medicines as a heart failure treatment. However, s-MRAs can cause high blood potassium, a dangerous and potentially fatal complication. Because of this, many physicians are hesitant to begin treatment with s-MRAs or discontinue treatment within several months, leaving patients again at risk of the complications of heart failure.

A newer class of mineralocorticoid receptor antagonists—nonsteroidal mineralocorticoid receptor antagonists (ns-MRSs)—is entering the market and is currently under evaluation for efficacy and side-effects. Thus far, ns-MRAs appear at least as effective as s-MRAs with lower rates of elevated blood potassium.

In addition to ns-MRAs, new drugs working as potassium-lowering agents are also now available. They replace older potassium-lowering drugs that were rarely used because they could cause the death of bowel tissue.

Pitt notes that the development of new ns-MRAs and the availability of new potassium-lowering agents "hold the promise of further improving cardiovascular outcomes in patients with heart failure, chronic renal disease, diabetes mellitus and/or resistant hypertension."