IN 1999, spironolactone (Aldactone) was about to draw its pension after nearly 40 years of service in the NHS when cardiologists decided it was the next best thing for severe heart failure. Within a few months, it shot from just another jobbing diuretic to become a highly prized aldosterone receptor blocker, capable of targeting heart failure pathology that other therapies could not reach. "At that time, life was pretty miserable for people with serious heart failure because they only had diuretics for the fluid retention, which could often be massive, angiotensin-converting enzyme inhibitors, which had been around for more than a decade, and digoxin, which was used in the absence of anything else. But patients didn't do very well, were frequendy admitted to hospital and were at a very high risk of death," recalls Martin Cowie, professor of cardiology, Imperial College London (Royal Brompton Hospital).
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