Randomized ALdactone Evaluation Study (RALES)

Introduction

Study characteristics:

• 36 month study, N = 1663, age: 65 +/- 12 years
• class III heart failure 70%; class IV 30%
• LVEF 25%
• ischemic & non-ischemic cardiomyopathy
• mean dose of ACE inhibitor
  • captopril 62 mg QD
  • enalapril 15 mg QD
  • lisinopril 15 mg QD
• exclusion
  • operative valvular heart disease
  • serum creatinine > 2.5 mg/dL
  • serum K+ > 5.0 meq/L
• standard diet
• 10% taking beta blockers

Conclusions:

• 27% reduction in mortality with dose of 25 mg spironolactone QD
• benefits in patients regardless of age
• benefit in combination with conventional therapy
• benefit diminished without digoxin or ACE inhibitor
• little risk of hyperkalemia (2% serious hyperkalemia)

Spironolactone reduced mortality in patients with congestive heart failure by 30%

More general terms

• clinical trial

Additional terms

• spironolactone (Aldactone)