All rights reserved. Subject to Notice of rights. ISBN: Outcomes No of Participants (studies) Follow up Quality of the evidence (GRADE) Relative effect Anticipated absolute effects Risk with Placebo Risk difference with Mineralocorticoid receptor antagonist (95% CI) Renal failure (not defined) VERY LOWb,e due to risk of bias, imprecision (from 12 fewer to 13 more) Gynaecomastia - Spironolactone 1217 MODERATEe due to risk of bias (from 31 more to 177 more) Gynaecomastia (or other breast disorders) - Eplerenone VERY LOWb,e due to risk of bias, imprecision Peto odds ratio (from 3 fewer to 3 more) LOWb,e due to risk of bias, imprecision (from 6 fewer to 29 more) (a) Downgraded by one increment as the majority of the evidence included an indirect population (not on beta-blockers). (b) Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs. (c) Downgraded by 1 increment because: Heterogeneity, I2=63%, unexplained by subgroup analysis. (d) Control group risk based on risk reported in EMPHASIS, as that population were on current first line treatment including beta-blockers. (e) Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias. (f) Control group risk based on risk reported in EMPHASIS, as it carries the vast majority of the weight in the meta-analysis. (g) EMPHASIS - serum potassium > 5.5 mmol/L. RALES serum potassium 5.5 mmol/L. Udelson 2010 - no definition. Tsutsui 2017 no definition. (h) Downgraded by 1 or 2 increments because: Heterogeneity, I2=79%, p=0.002, unexplained by subgroup analysis. (i) Peto odds ratio due to zero events in one trial.j Downgraded by 1 increment because: Heterogeneity, I2=59%, unexplained by subgroup analysis. 