Breakthrough Mineralocorticoid Receptor Agonists in Cardiovascular Care
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11m 14s
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16m 19s
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20m 27sPart 1 | Session 5 Panel Discussion and Audience Q&A
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3m 41sPart 1 | Session 1 Introduction and Landscape Overview by Dr Vijay Chopra
In this expert session, Dr Javed Butler presents a clear, clinically focused overview of how to overcome real world barriers to optimising aldosterone and potassium management in patients with heart failure and chronic kidney disease. Drawing on major guidelines and evidence summarised in the accompanying slides, he explains why aldosterone remains a central therapeutic target across HFrEF, HFpEF, resistant hypertension, CKD, and post MI populations.
The presentation highlights three decades of data showing that higher aldosterone levels consistently predict worse cardiovascular and renal outcomes, and demonstrates how comprehensive RAAS inhibition using ACE inhibitors, ARBs, ARNIs, and mineralocorticoid receptor antagonists (MRAs) provides substantial morbidity and mortality benefits.
Dr Butler also addresses the key practical barrier to implementing guideline directed RAASi and MRA therapy: hyperkalaemia. He reviews real world findings showing:
• How reducing or discontinuing RAAS inhibitors increases heart failure hospitalisations, CKD progression, and mortality
• The high prevalence and recurrence of hyperkalaemia in CKD, HF, and diabetes
• Why many patients never reach evidence based MRA doses due to potassium concerns
• The importance of maintaining potassium between 4.0 and 5.0 mmol/L for safety and outcomes
He then outlines a practical, stepwise approach to preserving life saving RAASi therapy correcting reversible contributors, reviewing medication lists, adjusting diuretics, and using lower but consistent doses rather than stopping treatment altogether.
Finally, the session highlights the role of modern potassium binders, including sodium zirconium cyclosilicate and patiromer, which allow clinicians to safely continue or uptitrate RAAS inhibitors and MRAs, reinforcing guideline recommendations that hyperkalaemia should not routinely lead to withdrawal of RAAS based therapy.
In this expert-led webinar moderated by Dr Vijay Chopra, leading clinicians review current and emerging strategies in aldosterone modulation, hyperkalaemia management, and cardiorenal therapeutics.
Dr Javed Butler opens with a practical overview of aldosterone’s central role in heart failure and CKD, emphasising the importance of achieving guideline-directed RAAS inhibitor and MRA dosing. He outlines real-world barriers posed by hyperkalaemia and provides clear strategies to maintain life-saving therapy safely, including the use of modern potassium binders.
Dr Dinesh Khullar presents the clinical evidence for finerenone, a non-steroidal MRA with improved selectivity and a lower risk of hyperkalaemia. He summarises key findings from FIDELITY, CONFIDENCE, and FINEARTS-HF, demonstrating meaningful reductions in CKD progression, heart failure events, albuminuria, and cardiovascular risk, particularly when combined with SGLT2 inhibitors.
Prof John McMurray explores the future of aldosterone-targeted therapy with aldosterone synthase inhibitors (ASIs). He reviews promising hypertension data for agents such as baxdrostat and outlines large-scale ongoing trials investigating ASIs in HFrEF, HFpEF, CKD, and heart failure prevention, pointing toward a major shift in proactive cardiorenal care.
The session concludes with a dynamic panel discussion addressing potassium thresholds, binder selection, chronic vs acute hyperkalaemia tolerance, insights from the PODCAST trial, and the scientific rationale behind combining MRAs and ASIs.
Overall, this webinar offers a concise, clinically relevant look at today’s best practices and tomorrow’s innovations in cardiorenal medicine.
For more on emerging strategies in aldosterone inhibition, read Cardiac Failure Review Journal’s Special Focus Issue on “New Mineralocorticoid Receptor Antagonists/Aldosterone Antagonists”.
Key Learning Objectives
- Identify clinical barriers associated with traditional aldosterone management and recognize the impact of hyperkalemia on patient outcomes and treatment adherence
- Evaluate the clinical evidence supporting non-steroidal MRAs, particularly finerenone, and understand their role in modern cardiovascular therapeutic strategies
- Apply practical strategies for implementing breakthrough MRA therapies while managing potassium levels and optimizing patient safety profiles
- Distinguish between different approaches to mineralocorticoid pathway modulation, including receptor antagonism and aldosterone synthesis inhibition
- Integrate evidence-based protocols for MRA therapy selection and monitoring in patients with hypertension and heart failure
- Assess patient-specific factors that influence MRA therapy choice and develop personalized treatment approaches for diverse cardiovascular populations
Target Audience
- Cardiologists and interventional cardiologists managing heart failure and hypertensive patients
- Clinical pharmacologists specializing in cardiovascular therapeutics
- Heart failure specialists and advanced heart failure practitioners
- Cardiovascular medicine fellows and cardiology residents
- Nephrology specialists managing patients with cardiovascular comorbidities
More from this programme
Part 1
Breakthrough Mineralocorticoid Receptor Agonists in Cardiovascular Care
In this expert-led webinar moderated by Dr Vijay Chopra, leading clinicians review current and emerging strategies in aldosterone modulation, hyperkalaemia management, and cardiorenal therapeutics.
Dr Javed Butler opens with a practical overview of aldosterone’s central role in heart failure and CKD, emphasising the importance of achieving guideline-directed RAAS inhibitor and MRA dosing. He outlines real-world barriers posed by hyperkalaemia and provides clear strategies to maintain life-saving therapy safely, including the use of modern potassium binders.
Dr Dinesh Khullar presents the clinical evidence for finerenone, a non-steroidal MRA with improved selectivity and a lower risk of hyperkalaemia. He summarises key findings from FIDELITY, CONFIDENCE, and FINEARTS-HF, demonstrating meaningful reductions in CKD progression, heart failure events, albuminuria, and cardiovascular risk, particularly when combined with SGLT2 inhibitors.
Prof John McMurray explores the future of aldosterone-targeted therapy with aldosterone synthase inhibitors (ASIs). He reviews promising hypertension data for agents such as baxdrostat and outlines large-scale ongoing trials investigating ASIs in HFrEF, HFpEF, CKD, and heart failure prevention, pointing toward a major shift in proactive cardiorenal care.
The session concludes with a dynamic panel discussion addressing potassium thresholds, binder selection, chronic vs acute hyperkalaemia tolerance, insights from the PODCAST trial, and the scientific rationale behind combining MRAs and ASIs.
Overall, this webinar offers a concise, clinically relevant look at today’s best practices and tomorrow’s innovations in cardiorenal medicine.
Faculty Biographies
Javed Butler
Professor of Medicine
Dr Javed Butler is President, Baylor Scott and White Research Institute, Senior Vice President for the Baylor Scott and White Health and Professor of Medicine at the University of Mississippi, US. He is board certified in cardiovascular medicine and advanced heart failure and transplant medicine. His research interests focus on clinical trials in patients with heart failure.
He serves on several national committees for the American College of Cardiology, American Heart Association, National Institutes of Health, and the Heart Failure Society of America. He is the recipient of the Simon Dack Award by the American College of Cardiology as well as the Time, Feeling, and Focus Award by the American Heart Association.
Prof Butler has authored more than 900 peer-reviewed publications. He serves on the editorial board of several peer reviewed cardiovascular journals and has been cited numerous times in America’s Best Doctors list.
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