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This review explores the complex interplay between hyperkalemia and the use of guideline-directed medical therapies (GDMT), such as reninangiotensinaldosterone system inhibitors (RAASi) and steroidal mineralocorticoid receptor antagonists (sMRAs), including spironolactone and eplerenone, which are currently recommended in guidelines for improving outcomes in heart failure with reduced ejection fraction (HFrEF)