ACC/AHA/HFSA guidelines add that MRA might be considered in patients with EF ≥ 45%, elevated B-type natriuretic peptide (BNP), or HF hospitalization within 1 year, no stage 4 or 5 chronic kidney disease or hyperkalemia [3], reflecting the positive results of the Treatment of Preserved Cardiac Function HF with an Aldosterone Antagonist (TOPCAT) trial in the USA (see below). The gene discussed is NPPB; the disease is chronic kidney disease.