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Turning to Drugs for Heart Failure

While there have been setbacks in recent research, drugs remain the most common effective heart-failure treatment.

Aldosterone Blockers

Some of the most significant breakthroughs in drugs for heart-failure treatment have come from the aldosterone blockers, such as Aldactone (spironolactone), and more recently, Inspra. Like ACE inhibitors, these drugs work by affecting the hormones in the bloodstream, in this case, aldosterone, which can cause the retention of salt and water and other ill effects.

While Aldactone can have some unpleasant side effects -- such as impotence and gynecomastia (breast swelling in men) -- Inspra does not cause them. Both drugs can cause an increase in potassium levels, so patients need to be monitored. One significant difference between the drugs is price: Aldactone, having been around for decades as a high blood-pressure drug, is significantly cheaper than Inspra, which was approved in September 2002.

Bertram Pitt, MD, who has led major studies of both of these drugs for heart-failure treatment believes Aldactone may still be the best drug for those who aren't concerned about side effects. But for some, side effects are an important issue.

While the reduction in side effects is important, the greater significance of the study, according to Pitt, is that it demonstrates the importance of blocking aldosterone. The most recent study testing Inspra is the second that shows aldosterone blockade makes a difference, Pitt tells WebMD. "There were a lot of people on the fence before, and I think this study will lead to more clinical investigation."

More study of Inspra is needed since this drug has largely been studied in people who had suffered from a recent heart attack and not heart failure. But the results are exciting for people with heart failure, according to Konstam. "In the last 10 years of drug therapy, there have been three big stories," he says. "First were the ACE Inhibitors, then the beta-blockers in the mid-90s, and now the aldosterone [blockers]."

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