Clinical implications of aldosterone blockade.
BACKGROUND
Aldosterone contributes to hypertension, cardiac and vascular remodeling, and heart failure. The significant risk reduction provided by the addition of spironolactone to standard therapy in patients with severe heart failure has renewed interest in aldosterone blockade.


METHODS
This review describes recent clinical studies of eplerenone, a selective aldosterone blocker, in patients with hypertension.


RESULTS
In a 16-week study, eplerenone was more effective than placebo or losartan in lowering systolic blood pressure (BP) and diastolic BP in black patients with mild to moderate hypertension. The BP-lowering efficacy of eplerenone was similar in blacks and whites. In a separate study in patients whose BP was controlled inadequately by angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, addition of eplerenone significantly reduced systolic BP, and to a lesser extent, diastolic BP. There were no significant changes in potassium levels in this study. Eplerenone increased active renin and aldosterone levels, indicating that it blocks the renin-angiotensin-aldosterone system. Gynecomastia, or breast tenderness, was uncommon and occurred at a rate comparable to placebo.


CONCLUSIONS
Eplerenone is a selective aldosterone blocker that effectively lowers BP in both white and black patients with hypertension and provides meaningful further antihypertensive efficacy when added to patients whose hypertension is inadequately controlled by angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers.
Weber
Michael A
MA
SUNY Health Science Center at Brooklyn, Brooklyn, NY 11203, USA. michaelwebermd@cs.com
D000450:Aldosterone / Q000502:physiology*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D044383:Black People; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D002986:Clinical Trials as Topic; D000077545:Eplerenone; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D007674:Kidney Diseases / Q000209:etiology / Q000517:prevention & control; D019808:Losartan / Q000627:therapeutic use; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D011188:Potassium / Q000097:blood; D012084:Renin-Angiotensin System / Q000187:drug effects; D013148:Spironolactone / Q000031:analogs & derivatives* / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000450:Aldosterone; D000077545:Eplerenone; D019808:Losartan; D011188:Potassium