Vnitr Lek 2026, 72(2):113-116 | DOI: 10.36290/vnl.2026.023

Spironolactone in the treatment of heart failure and resitant arterial hypertension

Filip Málek

Kardiologická klinika 1. lékařské fakulty UK a Nemocnice Na Homolce, Praha

Chronic heart failure is clinical syndrome charatcterised by increasing prevalence and unfavorable prognosis. Resistent arterial hypertension increases the risk of cardiovascular events and the risk of death from cardiovascular causes. Both heart failure and resistant arterial hypertension are associated with secondary hyperaldosternism. Spironolactone blocks the adverse effects of aldosterone on the level of its receptors Its efficacy in the indications of heart failure and resistant arterial hypertension is supported by scientific findings, it is also supported by the guidelines from professional societies.Spironolactone reduces mortality and morbidity of patients with heart failure and reduced ejection fraction. During a median follow-up of 24 months, there was a 30% reduction in the risk of death from any cause (relative risk 0.70, p < 0.001). Spironolactone treatment was also associated with a 35% reduction in the risk of hospitalization for worsening heart failure compared with placebo (relative risk 0.65, p < 0.001) and resulted in symptomatic improvement according to NYHA functional class. Randomized trials have shown its effectiveness in lowering of blood pressure in patients with resistant arterial hypertension.

Keywords: spironolactone, aldosterone, heart failure, resistant arterial hypertension.

Accepted: March 25, 2026; Published: April 8, 2026  Show citation