Thiazides work on the distal convoluted tubule, loops on the thick ascending limb, and potassium-sparers like spironolactone on the collecting duct, blocking aldosterone. But for my heart failure patients, I choose eplerenone over spironolactone every time. My brother took spironolactone and the gynaecomastia broke his spirit more than the illness, so now I reach for the selective one. Watching him stare at his old cricket jersey, I promised myself that.
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