NICE recommend offering or considering the addition of an aldosterone antagonist (AA), such as spironolactone and eplerenone, to treatment with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB) for management of treatment-resistant heart failure or hypertension and for patients who have had an acute MI and who have symptoms and/or signs of heart failure and left ventricular systolic dysfunction.
NICE also recommend checking blood pressure before and after each AA dose increment and monitoring potassium, creatinine and eGFR at defined regular intervals.
A study using CPRD data published in BMJ Open examined recorded biochemical monitoring for patients prescribed AAs in UK primary care. Less than one-third of patients taking ACEI/ARB with an AA had biochemical monitoring within 2 weeks of starting an AA. The authors conclude that Higher levels of monitoring may reduce adverse biochemical events.