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Aldosterone blockade and heart failure.

In the fall of 1999, a multicenter, randomized trial examining the effect of spironolactone on morbidity and mortality among patients with severe heart failure was published in the Journal.1 The Randomized Aldactone Evaluation Study (RALES) proved that antagonism of aldosterone had an important role in the management of heart failure, even in patients taking angiotensin-converting–enzyme (ACE) inhibitors. In addition to reducing mortality by 30 percent, small doses of spironolactone resulted in an improvement in ventricular function and enhanced exercise tolerance.2 The rates of death from progressive heart failure and sudden death from cardiac causes were both diminished by an . . .