MRAs in HFmrEF and HFpEF \u2014 Where Do We Stand in 2026?<\/p>\n
\u2022\u2060 \u2060Medical News Source:ReachMD \/ PACE-CME, 19 May 2026<\/p>\n
\u2022\u2060 \u2060MRAs such as:
\n* Spironolactone
\n* Eplerenone
\ncontinue to play a selective role in HFmrEF\/HFpEF.
\n\u2022\u2060 \u2060According to current ESC\/ACC guidelines:
\n* MRAs carry a Class IIb (\u201cmay be considered\u201d) recommendation
\n* Particularly in:
\n* Lower-range EF
\n* DM
\n* CKD
\n* Elevated BNP
\n* Recurrent HF hospitalization
\n\u2022\u2060 \u2060Main supporting HFpEF trial:
\n* TOPCAT
\n\u2022\u2060 \u2060Evidence is mainly extrapolated from HFrEF studies and subgroup analyses.
\n\u2022\u2060 \u2060Potential benefit appears greater in patients:
\n* Closer to reduced EF
\n* With structural heart disease
\n* With elevated natriuretic peptides
\n\u2022\u2060 \u2060Main limitations of traditional steroidal MRAs:
\n* Hyperkalemia
\n* Renal dysfunction
\n* Hormonal adverse effects
\n* Need for close potassium\/renal monitoring
\n\u2022\u2060 \u2060There is increasing interest in newer nonsteroidal, non-hormonal selective MRAs such as:
\n* Finerenone
\n\u2022\u2060 \u2060Potential advantages of finerenone:
\n* More selective non-steroidal receptor inhibition
\n* Better suitability in CKD or DM
\n* Possibly lower side effects such as:
\n* Hyperkalemia burden
\n* Gynecomastia
\n\u2022\u2060 \u2060Major supportive finerenone trial:
\n* FINEARTS-HF
\n\u2022\u2060 \u2060Importantly:
\n* Finerenone data are increasingly promising,
\n* but traditional steroidal MRAs remain the current guideline-based standard HF therapy.
\n\u2022\u2060 \u2060Link:<\/p>\n