MRAs in HFmrEF and HFpEF — Where Do We Stand in 2026?
MRAs in HFmrEF and HFpEF — Where Do We Stand in 2026?
• Medical News Source:ReachMD / PACE-CME, 19 May 2026
• MRAs such as:
* Spironolactone
* Eplerenone
continue to play a selective role in HFmrEF/HFpEF.
• According to current ESC/ACC guidelines:
* MRAs carry a Class IIb (“may be considered”) recommendation
* Particularly in:
* Lower-range EF
* DM
* CKD
* Elevated BNP
* Recurrent HF hospitalization
• Main supporting HFpEF trial:
* TOPCAT
• Evidence is mainly extrapolated from HFrEF studies and subgroup analyses.
• Potential benefit appears greater in patients:
* Closer to reduced EF
* With structural heart disease
* With elevated natriuretic peptides
• Main limitations of traditional steroidal MRAs:
* Hyperkalemia
* Renal dysfunction
* Hormonal adverse effects
* Need for close potassium/renal monitoring
• There is increasing interest in newer nonsteroidal, non-hormonal selective MRAs such as:
* Finerenone
• Potential advantages of finerenone:
* More selective non-steroidal receptor inhibition
* Better suitability in CKD or DM
* Possibly lower side effects such as:
* Hyperkalemia burden
* Gynecomastia
• Major supportive finerenone trial:
* FINEARTS-HF
• Importantly:
* Finerenone data are increasingly promising,
* but traditional steroidal MRAs remain the current guideline-based standard HF therapy.
• Link:
