The Mechanism of Action of Mineralocorticoid Receptor Antagonists in Heart Failure with Reduced Ejection Fraction.

Mineralocorticoid receptor antagonists (MRAs) are one of the guideline-directed medical therapies for patients with heart failure and chronic kidney disease due to their anti-inflammatory and antifibrotic effects. MRAs regulate mineralocorticoid receptor (MR) signaling by inhibiting aldosterone binding to MR. MRAs are classified into steroidal and nonsteroidal categories based on their molecular interactions and clinical applications. Steroidal MRAs have been widely used in clinical practice and have demonstrated significant efficacy. Continuous advancements in the field have led to the development of nonsteroidal MRAs with greater receptor selectivity and better safety profile.