Spironolactone, Clinical Evidence

Current guidelines recommend the use of diuretics in all patients with heart failure and fluid retention. Diuretics should not be used as monotherapy, and dosage adjustment may be required, depending on the effects desired and the occurrence of any adverse effects. Spironolactone has been shown to improve survival in adults with heart failure. [Pitt: 1999] The exact reason for this remarkable survival benefit is still being investigated. Possibilities include the beneficial effect of spironolactone’s attenuation of aldosterone-induced myocardial fibrosis, or catecholamine release, or both. Recent evidence suggests that angiotensin-converting enzyme inhibitors may potentiate the diuretic effect of spironolactone. [Captopril-Digoxin: 1988]