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Spironolactone has been a well-known diuretic of choice in treatment of ascites. It has alsobeen used in the treatment of edema and hypertension. Recent data supported the evidence ofaldosterone escape in patients with heart failure after treatment with angiotensin converting enzyme inhibitors. This partial escape of renin angiotensin aldosterone blockade leads to the additional potential therapeutic effect of spironolactone. As an aldosterone receptor blocker, spironolactone may exhibit a therapeutic effect in patients with aldosterone escape phenomenon. Several clinical studies have been conducted to explore this new approach in patients with congestive heart failure and other cardiovascular diseases/disorders. Preliminary data supported the possible benefit in several groups of patients including heart failure, hypertension, acutemyocardial infarction. At the present time, these data are limited to certain clinical conditions and may not be able to apply in all general clinical settings. The available publications are extensively reviewed in this paper. Further clinical efficacy evaluation should be conducted to support the use of spironolactone for its new indications. In conclusion, spironolactone, as an aldosterone blocker, is being investigated as an adjunctive drug of choice in patients with aldosterone escape phenomenon.
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