醛固酮受体拮抗剂在心力衰竭的应用.ppt

Cr should be ≤221 μmol/L in men or ≤ 176.8 umol/L in women (or eGFR 30 mL/min/1.73 m2), and K should be ≤ 5.0 mmol/L. Careful monitoring of K, renal function, and diuretic dosing should be performed at initiation and closely followed thereafter to minimize risk of hyperkalemia and renal insufficiency. (CLASS I, Levelof Evidence: A) Aldosterone receptor antagonists are recommended to Inappropriate use of aldosterone receptor antagonists is potentially harmful because of life-threatening hyperkalemia or renal insufficiency when serum creatinine is 221 μmol/L in men or 176.8 μmol/L in women(or GFR30 mL/min/1.73 m2),and/or K 5.0 mmol/L. (CLASS Ⅲ Level of Evidence: B) 若起始用药后血K升高≤6 mmol/L或出现肾功能恶化，则不加量直至血K 5 mmol/l。确定高钾血症或肾功能不全去除后72h可考虑减量再使用。 Strategies to Minimize the Risk of Hyperkalemia in Patients Treated With Aldosterone Antagonists The risk of hyperkalemia increases progressively when Cr is141.4 μmol/L, or GFR 30 mL/min/1.73 m2. Baseline serum K5.0 mmol/L. An initial dose of spironolactone of 12.5 mg or eplerenone 25 mg is typical. The risk of hyperkalemia is increased with concomitant use of higher doses of ACE inhibitors (captopril75 mg daily; enalapril or lisinopril10 mg daily). In most circumstances, potassium supplements are discontinued or reduced. Close monitoring of serum potassium is required; K levels and renal function are most typically checked in 3 d and at 1 wk after initiating therapy and at least monthly for the first 3 mo, and every 3 months thereafter. Conclusions and Relevance In this randomized controlled trial, long-term aldosterone receptor blockade improved left ventricular diastolic function but did not affect maximal exercise capacity, patient symptoms, or quality of life in patients with heart failure with preserved ejection fraction. Whether the improved left ventricular function observed in the Aldo-DHF trial is of clinical significance requires further investigation in larger populations. 醛固酮受体拮抗剂在慢性心力衰竭（原发病为瓣膜病、LVEF保留的心力衰竭、慢性