Effects of mineralocorticoid receptor antagonists on coronary microcirculation: a mini-review

Mineralocorticoid receptor antagonists (MRAs) serve as a foundational therapies in the management of heart failure, hypertension, and chronic kidney disease. Their primary therapeutic efficacy stems from the competitive antagonism of the mineralocorticoid receptor (MR), which mitigates pathological cascades such as endothelial dysfunction, oxidative stress, chronic inflammation, and perivascular fibrosis. Coronary microvascular dysfunction (CMD)—a pivotal pathological driver across a spectrum of cardiovascular diseases—is defined by impaired vasodilation, heightened microvascular resistance, and diminished coronary flow reserve (CFR). Given that CMD is inextricably linked to dysregulated MR signaling, the restoration of microvascular function represents a key mechanism through which MRAs exert their cardioprotective effects. This review delineates the physiological mechanisms, diagnostic indicators, and generational evolution of MRAs in the context of coronary microcirculation. By synthesizing evidence from animal and clinical studies, this work clarifies the therapeutic utility of MRAs for microvascular protection and provides a comprehensive framework for understanding their pharmacological role in CMD research.