Trial reportJACC. Heart failure2020
Mineralocorticoid Receptor Antagonists, Blood Pressure, and Outcomes in Heart Failure With Reduced Ejection Fraction.
Trial report in JACC. Heart failure, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 2 syntheses or guidelines pooled it, 85 citations in OpenAlex.
- Pooled it
- Pooled it
- Efficacy and safety of vericiguat in patients with heart failure with reduced ejection fraction and asymptomatic hypotension: insights from a multicenter observational cohort study.BMC cardiovascular disorders · 2026Observational
- Mineralocorticoid receptor antagonists for the treatment of heart failure and kidney disease: a state-of-the-art review.Heart failure reviews · 2026Review
- Evolving Mineralocorticoid Receptor Antagonism: a Narrative Review on Differences between Steroidal MRAs, Non-Steroidal MRAs and Aldosterone Synthase Inhibitors in Cardiorenal Disease.Current heart failure reports · 2026Review
- Pharmacotherapy in Polish patients with heart failure with reduced ejection fraction: is it optimal?Cardiology journal · 2026Article
- Heart Failure with Preserved Ejection Fraction: Challenges and Current Approaches.Research in heart yield and translational medicine · 2026Review
- Mineralocorticoid Receptor Antagonist Use in Contemporary Heart Failure Care.Cardiac failure review · 2026Review
- Identification and prognosis of low office and ambulatory blood pressure in patients with heart failure.Annals of medicine · 2025Article
- An individual treatment effect approach to predict response to mineralocorticoid receptor antagonists in patients with heart failure and reduced ejection fraction.European journal of heart failure · 2025Article
- Dose optimization and utilization trends of mineralocorticoid receptor antagonists in heart failure patients with reduced ejection fraction in Ethiopia.American heart journal plus : cardiology research and practice · 2025Article
- Comparison of Quadruple Therapy Sequencing Strategies for Heart Failure With Reduced Ejection Fraction.Journal of the American Heart Association · 2025Article
- Review
- The Feasibility of a Guideline-Directed Medical Therapy Rapid Up-Titration Programme Among Real-World Heart Failure Patients: A Multicentre Observational Study.Journal of clinical medicine · 2025Article
- Population Gap for Chronic Heart Failure Patients Between Randomized Controlled Trials and Japan's Super-Aged Society.Circulation reports · 2025Article
- COAPT Trial at 5 Years: Same Doubts Remain About the Efficacy of Transcatheter Edge-to-Edge in Functional Mitral Regurgitation.Brazilian journal of cardiovascular surgery · 2024Article
- Sequencing Quadruple Therapy for Heart Failure with Reduced Ejection Fraction: Does It Really Matter?Heart failure clinics · 2024Review
- Adverse Effects of Aldosterone: Beyond Blood Pressure.Journal of the American Heart Association · 2024Review
- Reassessing the management of hypertension: Time to prevent aldosterone-mediated heart failure.European journal of heart failure · 2024Article
- Initiation and Up-titration of Guideline-directed Medical Therapy for Patients with Heart Failure: Better, Faster, Stronger!Cardiac failure review · 2024Review
Corrections and comments
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Authors and funding
11 authors at 6 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe purpose of this study was to investigate the effects of mineralocorticoid receptor antagonists (MRAs) on systolic blood pressure (SBP) and outcomes according to baseline SBP in patients with heart failure with reduced ejection fraction (HFrEF).
backgroundMRAs are greatly underused in patients with HFrEF, often because of fear of adverse events. Concern about hypotension has been raised by the demonstration that MRAs are particularly effective treatment for resistant hypertension.
methodsThe effect of MRA therapy was studied in 4,396 patients with HFrEF randomized in the RALES (Randomized Aldactone Evaluation Study) and EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure) trials.
resultsMean SBP change from baseline to 6 months was +1.4 ± 18.1 mm Hg in the placebo group and -1.2 ± 17.9 mm Hg in the MRA group. The between-treatment difference was 2.6 mm Hg (95% confidence interval [CI]: 1.5 to 3.6; p < 0.001). All outcomes were reduced by MRA therapy overall, with consistent effects across SBP categories (e.g., all-cause mortality, overall hazard ratio [HR] of 0.72; 95% CI: 0.64 to 0.82; p < 0.001; SBP ≤105 mm Hg; HR: 0.72; 95% CI: 0.56 to 0.94; SBP >105 to ≤115 mm Hg; HR: 0.78; 95% CI: 0.60 to 1.02; SBP >115 to ≤125 mm Hg; HR: 0.71; 95% CI: 0.53 to 0.94; SBP >125 to ≤135 mm Hg; HR: 0.79; 95% CI: 0.57 to 1.10; and SBP > 135 mm Hg; HR: 0.67; 95% CI: 0.50 to 0.90; p for interaction = 0.95). Hypotension was infrequent and not more common with MRA therapy than with placebo, overall (4.6% vs. 3.9%; p = 0.25) or in any SBP category.
conclusionsMRA treatment had little effect on SBP in patients with HFrEF, and the clinical benefits were not modified by baseline SBP. MRA treatment infrequently caused hypotension, even when the baseline SBP was low. The treatment discontinuation rates between MRA and placebo therapy were similar. Low SBP is not a reason to withhold MRA therapy in patients with HFrEF.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.