Additional Information Necessary

The Treatment of Heart Failure With Reduced Ejection Fraction by Dr. med. Dominik Berliner, Dr. med. Anja Hänselmann, Prof. Dr. med. Johann Bauersachs in issue 21/2020

The literature review by Berliner et al. (1), “The treatment of heart failure with reduced ejection fraction”, covers the topic comprehensively. Among the recommended pharmacological treatment approaches, spironolactone is listed as a mineralocorticoid receptor antagonist and its typical side effects and the target daily dose of 1 × 50 mg are mentioned. Especially for spironolactone, very good outcomes were reported for a daily dose of 1 × 25 mg which was used, on average, in the RALES study (2).

Later studies on prescription behavior and complications conducted after the publication of the RALES study assessed how treatment with spironolactone, frequently in doses higher than 1 × 25 mg, in combination with ACE inhibitors increased the risk of severe hyperkaliemia (3). In patients taking spironolactone, it is highly recommended to monitor electrolyte levels at close intervals.

In my opinion, a target daily dose of 1 × 50 mg should not be stated in the recommendations without comment (see Table 2 of the article). Furthermore, the article does not discuss syndromes with involvement of heart and kidney, two organs which frequently have a mutual influence on each other. Here, it is a rewarding challenge to develop a treatment that take both organ functions into account (4).

DOI: 10.3238/arztebl.m2021.0045

Prof. Dr. med. Peter R. Mertens

Klinik für Nieren- und Hochdruckkrankheiten, Diabetologie

und Endokrinologie

Otto-von-Guericke Universität Magdeburg

Magdeburg, Germany

Conflict of interest

The author declares no conflict of interest.

References

1. Berliner D, Hänselmann A, Bauersachs J: The treatment of heart failure with reduced ejection fraction. Dtsch Arztebl Int 2020; 117: 376–86

2. Pitt B, Zannad F, Remme WJ: The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized aldactone evaluation study investigators. N Engl J Med 1999; 341: 709–17

3. Wrenger E , Müller R, Moesenthin M, Welte T, Frölich JC, Neumann KH: Interaction of spironolactone with ACE inhibitors or angiotensin receptor blockers: analysis of 44 cases Brit Med J 2003; 327: 147

4. Scurt FG, Kuczera T, Mertens PR, Chatzikyrkou C: [The Cardiorenal Syndrome]. Dtsch Med Wochenschr 2019; 144: 910–6