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Spironolactone reduced HF events in some patients with HF with preserved ejection fraction, but the results were not generalizable to all patients with HF with preserved ejection fraction. More recently, the nonsteroidal MRA finerenone improved the HF outcomes of patients with HF with preserved ejection fraction, expanding the benefits previously seen among patients with diabetes and albuminuric chronic kidney disease. The use of MRAs has been limited due to excessive concern about hyperkalemia. Education about the limited true risk associated with hyperkalemia, and about how to predict, prevent, and manage hyperkalemia, may lead to wider acceptability and use of these agents. Several ongoing trials are testing steroidal and nonsteroidal MRAs in HF populations. In this review, we perform a critical appraisal of MRA use in HF populations and point toward future directions.<\/jats:p>","DOI":"10.1161\/circheartfailure.124.011629","type":"journal-article","created":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T05:00:34Z","timestamp":1732510834000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":39,"title":["Mineralocorticoid Receptor Antagonists in Heart Failure: An Update"],"prefix":"10.1161","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2304-6138","authenticated-orcid":true,"given":"Jo\u00e3o Pedro","family":"Ferreira","sequence":"first","affiliation":[{"name":"Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&amp;D Centre \u2013 UnIC@RISE, Faculty of Medicine of the University of Porto, Portugal (J.P.F.)."},{"name":"Heart Failure Clinic, Internal Medicine Department, Unidade Local de Saude de Gaia\/Espinho, Gaia, Portugal 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