Which aldosterone antagonist reduces mortality in heart failure?

• A. Furosemide
• B. Hydrochlorothiazide
• C. Digoxin
• D. Spironolactone

Answer: (D)

Blocking aldosterone’s effects in heart failure targets the hormone-driven remodeling and fluid retention that worsen prognosis. Aldosterone promotes sodium retention, potassium loss, and Fibrosis, contributing to adverse cardiac remodeling. By blocking its receptors, an aldosterone antagonist helps reduce this remodeling and the associated mortality risk.

Clinical trial evidence shows that adding spironolactone to standard therapy in patients with advanced heart failure significantly lowers death rates and hospitalizations. This mortality benefit goes beyond simple diuresis and is distinct from what typical diuretics achieve, which mainly relieve symptoms without improving survival. Digoxin, while it can help symptoms and exercise tolerance, has not shown a mortality benefit in this context.

So, spironolactone is the aldosterone antagonist shown to reduce mortality in heart failure.