In the RALES trial, which drug was shown to reduce mortality in patients with systolic heart failure by blocking the mineralocorticoid receptor?
- A Eplerenone
- B Spironolactone ✓
- C Finerenone
- D Furosemide
Correct answer: B. Spironolactone
Explanation
The RALES (Randomized Aldactone Evaluation Study) trial demonstrated that spironolactone 25 mg/day reduced mortality by 30% in patients with NYHA class III–IV heart failure with reduced ejection fraction. Eplerenone was studied in the EPHESUS trial (post-MI heart failure) and EMPHASIS-HF (mild heart failure). Finerenone is a nonsteroidal MRA studied in diabetic kidney disease (FIDELIO-DKD, FIGARO-DKD). Furosemide is a loop diuretic with no mortality benefit shown in heart failure trials.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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