Med. praxi. 2026;23(2):128-130 | DOI: 10.36290/med.2026.010

Spironolactone as the first-line treatment for HFrEF

prof. MUDr. Jiří Vítovec, CSc., FESC
I. interní kardioangiologická klinika Lékařské fakulty MU a FN u sv. Anny v Brně
Ústav farmakologie toxikologie Farmaceutické fakulty MU, Brno

Heart failure with reduced ejection fraction (HFrEF) is a highly prevalent and prognostically serious disease. Modern treatment is based on the concept of four pillars (ARNI/ACEI/ARB, beta-blocker, MRA, SGLT2 inhibitor). Spironolactone, as a mineralocorticoid receptor antagonist (MRA), has a solid position thanks to robust clinical evidence. The article summarizes its mechanism of action, clinical indications, principles of safe use, and a practical algorithm for initiating treatment.

Keywords: heart failure with reduced ejection fraction (HFrEF), mineralocorticoid receptors, spironolactone, indications.

Received: March 23, 2026; Revised: March 26, 2026; Accepted: March 26, 2026; Published: April 28, 2026  Show citation

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Vítovec J. Spironolactone as the first-line treatment for HFrEF. Med. praxi. 2026;23(2):128-130. doi: 10.36290/med.2026.010.
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