Aldosterone receptor antagonists or mineralocorticoid receptor antagonist (MRAs)

What they do

Aldosterone receptor antagonists, also called MRAs, block the effects of a hormone produced naturally by your adrenal glands which can cause your heart failure to get worse. Aldosterone receptor antagonists affect the balance of water and salts going into your urine and are weak diuretics. They help lower blood pressure, reduce congestion and thus protect the heart.

Aldosterone receptor antagonists have been shown to be particularly effective in advanced heart failure and are often taken together with other heart failure drugs.

What are the expected benefits?

Aldosterone receptor antagonists or MRAs have been shown to reduce heart failure-related hospitalisations, prolong life, and improve exercise tolerance and quality of life.

Side effects

This drug can sometimes affect kidney function and can also increase potassium levels. This is especially important for patients who also use ACE inhibitors or ARBs. Your doctor will monitor your kidney function and potassium levels through regular blood tests.

In some rare cases, aldosterone receptor antagonists can cause breast enlargement or tenderness, especially in men. The newer drugs don’t have this effect.

Also known as:

  • Spironolactone
  • Eplerenone
  • Combination products
    (Aldactide®, Lasilactone®)

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ESC Guidelines for Heart Failure

What patients need to know

This guide for patients from the European Society of Cardiology aims to provide an overview of the latest evidence-based recommendations for the diagnosis and treatment of heart failure.

In particular, it should help patients to understand the:

  • main types of heart failure
  • medicines used to treat heart failure
  • devices that may be appropriate
  • importance of rehabilitation
  • management by a multidisciplinary team
  • importance of self-care in managing your own condition

Learn more


A series of 9 simple, captivating animations explaining heart failure and its treatment.

These narrated animations explain how a healthy heart works, what happens to it in heart failure and how various treatments work to improve your health.


In this section you can watch, listen or read interviews with other people with heart failure and their caregivers.


and share your own views and experiences with other patients, families and caregivers. is a European Society of Cardiology website

The website was developed under the direction of the Heart Failure Association of the European Society of Cardiology (ESC). The ESC is a world leader in the discovery and dissemination of best practices in cardiovascular medicine. Our members and decision-makers are healthcare professionals who volunteer their time and expertise to represent professionals in the field of cardiology in Europe and beyond.

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