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Trends in Mortality From All Causes Among Hypertensive Adults in the United States 2012-05-16 Ŀ ¼ Background 1 Methods 2 Results 3 Disscussion 4 Background This article reviews the epidemiology of ADHF and the profile of patients suffering from this condition. It describes factors used in assessing prognosis and presents treatment options. Although no currently available treatments have been shown to favorably affect long-term outcomes, there are a variety of strategies and approaches to management that are expected to reduce morbidity and mortality following discharge after ADHF hospitalization. Methods The importance of the transition from hospital to the outpatient setting is described. Particular attention should be focused on providing health education to the patient and their family at an appropriate level of medical literacy as well as ensuring early follow-up evaluation after hospital discharge. Results Release of aldosterone is stimulated by decreased renal perfusion via angiotensin II, hyperkalemia, and possibly adrenocorticotropic hormone.2 Aldosterone exerts its effects by binding to mineralocorticoid receptors in renal epithelial cells. Aldosterone has several deleterious effects on the failing heart, primarily sodium and fluid retention, but also endothelial dysfunction, left ventricular hypertrophy, and myocardial fibrosis.2,3 Plasma aldosterone levels can be markedly elevated in patients with heart failure, likely due to activation of the reninangiotensin- aldosterone system. Elevated aldosterone and angiotensin II levels have been associated with higher mortality rates Disscussion While the differences between the two drugs remain to be determined, the most important differences in clinical practice are selectivity for receptors (and hence their antiandrogenic side effects) and price. Even though it is available as a generic drug, eplerenone still costs at least three times more than spironolactone for the same dosage and indication. Disscuss