{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T05:40:34Z","timestamp":1791092434017,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2013,4,8]],"date-time":"2013-04-08T00:00:00Z","timestamp":1365379200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brit J Clinical Pharma"],"published-print":{"date-parts":[[2013,5]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>Aldosterone antagonists (<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>ldo<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>s) have been used to treat severe chronic heart failure (<jats:styled-content style=\"fixed-case\">CHF<\/jats:styled-content>).There is uncertainty regarding the efficacy of using <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>ldo<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>s in mild to moderate <jats:styled-content style=\"fixed-case\">CHF<\/jats:styled-content> with <jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>ew <jats:styled-content style=\"fixed-case\">Y<\/jats:styled-content>ork <jats:styled-content style=\"fixed-case\">H<\/jats:styled-content>eart <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>ssociation (<jats:styled-content style=\"fixed-case\">NYHA<\/jats:styled-content>) classifications of <jats:styled-content style=\"fixed-case\">I<\/jats:styled-content> to <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content>. This study summarizes the evidence for the efficacy of spironolactone (<jats:styled-content style=\"fixed-case\">SP<\/jats:styled-content>), eplerenone (<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content>) and canrenone in mild to moderate <jats:styled-content style=\"fixed-case\">CHF<\/jats:styled-content> patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>PubMed, <jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content>, <jats:styled-content style=\"fixed-case\">EMBASE<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">OVID<\/jats:styled-content> databases were searched before <jats:styled-content style=\"fixed-case\">J<\/jats:styled-content>une 2012 for randomized and quasi\u2010randomized controlled trials assessing <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>ldo<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content> treatment in <jats:styled-content style=\"fixed-case\">CHF<\/jats:styled-content> patients with <jats:styled-content style=\"fixed-case\">NYHA<\/jats:styled-content> classes <jats:styled-content style=\"fixed-case\">I<\/jats:styled-content> to <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content>. Data concerning the study's design, patients' characteristics and outcomes were extracted. Risk ratio (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>) and weighted mean differences (<jats:styled-content style=\"fixed-case\">WMD<\/jats:styled-content>) or standardized mean difference were calculated using either fixed or random effects models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight trials involving 3929 <jats:styled-content style=\"fixed-case\">CHF<\/jats:styled-content> patients were included. <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>ldo<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>s were superior to the control in all cause mortality (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.79, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.66, 0.95) and in re\u2010hospitalization for cardiac causes (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.62, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.52, 0.74), the left ventricular ejection fraction was improved by <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>ldo<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content> treatment (<jats:styled-content style=\"fixed-case\">WMD<\/jats:styled-content> 2.94%, <jats:italic>P<\/jats:italic> = 0.52). Moreover, <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>ldo<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content> therapy decreased the left ventricular end\u2010diastolic volume (<jats:styled-content style=\"fixed-case\">WMD<\/jats:styled-content> \u221214.04\u2009ml, <jats:italic>P<\/jats:italic> &lt; 0.00001),the left ventricular end\u2010systolic volume (<jats:styled-content style=\"fixed-case\">WMD<\/jats:styled-content> \u221214.09\u2009ml, <jats:italic>P<\/jats:italic> &lt; 0.00001). A stratified analysis showed a statistical superiority in the benefits of <jats:styled-content style=\"fixed-case\">SP<\/jats:styled-content> over <jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> in reducing <jats:styled-content style=\"fixed-case\">LVEDV<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">LVESV<\/jats:styled-content>. <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>ldo<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>s reduced <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>\u2010type natriuretic peptide concentrations (<jats:styled-content style=\"fixed-case\">WMD<\/jats:styled-content> \u221237.76\u2009pg\u2009ml<jats:sup>\u22121<\/jats:sup>, <jats:italic>P<\/jats:italic> &lt; 0.00001), increased serum creatinine (<jats:styled-content style=\"fixed-case\">WMD<\/jats:styled-content> 8.69\u2009\u03bcmol\u2009l<jats:sup>\u22121<\/jats:sup>, <jats:italic>P<\/jats:italic> = 0.0003) and occurrence of hyperkalaemia (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 1.78, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.43, 2.23).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Additional use of <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>ldo<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>s in <jats:styled-content style=\"fixed-case\">CHF<\/jats:styled-content> patients may decrease mortality and re\u2010hospitalization for cardiac reasons, improve cardiac function and simultaneously ameliorate <jats:styled-content style=\"fixed-case\">LV<\/jats:styled-content> reverse remodelling.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bcp.12012","type":"journal-article","created":{"date-parts":[[2012,10,23]],"date-time":"2012-10-23T04:11:27Z","timestamp":1350965487000},"page":"1202-1212","source":"Crossref","is-referenced-by-count":39,"title":["Additional use of an aldosterone antagonist in patients with mild to moderate chronic heart failure: a systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"75","author":[{"given":"Li\u2010jun","family":"Hu","sequence":"first","affiliation":[{"name":"Department of cardiology Second Affiliated Hospital, Chongqing Medical University  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun\u2010qing","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of cardiology Second Affiliated Hospital, Chongqing Medical University  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Song\u2010bai","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of cardiology Second Affiliated Hospital, Chongqing Medical University  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian\u2010lin","family":"Du","sequence":"additional","affiliation":[{"name":"Department of cardiology Second Affiliated Hospital, Chongqing Medical University  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"She","sequence":"additional","affiliation":[{"name":"Department of cardiology Second Affiliated Hospital, Chongqing Medical University  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,4,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.5.572"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.1032017"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehl123"},{"key":"e_1_2_8_5_1","first-page":"5","article-title":"Guideline adherence in the treatment of chronic heart failure. 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