Effects of the selective aldosterone blocker eplerenone versus the calcium antagonist amlodipine in systolic hypertension.
Eplerenone is a highly selective aldosterone blocker, which is under development for the treatment of hypertension and heart failure. To assess its usefulness in older patients with systolic hypertension and widened pulse pressure, we compared the effects of eplerenone with amlodipine, on clinic blood pressure (BP) and pulse pressure and in a subset of the patients, ambulatory BP, vascular compliance, and urinary albumin excretion. The study involved 269 patients > or =50 years of age who were randomly assigned to either eplerenone (50 to 200 mg daily) or amlodipine (2.5 to 10 mg daily) in a double-blind titration to effect design. After 24 weeks of therapy, reductions in clinic systolic BP were similar for both treatments (eplerenone, -20.5+/-1.1 mm Hg; amlodipine, -20.1+/-1.1 mm Hg). Reductions in clinic diastolic BP were modestly larger on amlodipine (-6.9+/-0.7 mm Hg) compared with eplerenone (-4.5+/-0.7 mm Hg) (P=0.014). Pulse pressure was also reduced similarly from baseline by the 2 treatment groups (eplerenone, -15.9 mm Hg versus amlodipine, -13.4 mm Hg, P=0.07). Changes from baseline in pulse wave velocity after 24 weeks of therapy were statistically similar for eplerenone and amlodipine. In patients with microalbuminuria at baseline (>30 mg albumin/g creatinine), eplerenone reduced the urinary albumin/creatinine ratio by 52% compared with a reduction of 10% by amlodipine (P=0.04). Thus, eplerenone was as effective as amlodipine in lowering systolic BP and pulse pressure as well as pulse wave velocity in older patients with widened pulse pressure hypertension. Furthermore, eplerenone reduced microalbuminuria to a greater extent than amlodipine in this older patient group.
White
William B
WB
Section of Hypertension and Clinical Pharmacology, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, Conn 06030-3940, USA. wwhite @nso1.uchc.edu
Duprez
Daniel
D
St Hillaire
Richard
R
Krause
Scott
S
Roniker
Barbara
B
Kuse-Hamilton
Janice
J
Weber
Michael A
MA
D000368:Aged; D000419:Albuminuria / Q000652:urine; D017311:Amlodipine / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D003404:Creatinine / Q000652:urine; D003967:Diarrhea / Q000139:chemically induced; D004311:Double-Blind Method; D000077545:Eplerenone; D005260:Female; D006261:Headache / Q000139:chemically induced; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists; D009325:Nausea / Q000139:chemically induced; D011673:Pulsatile Flow / Q000187:drug effects; D013148:Spironolactone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D013599:Systole; D016896:Treatment Outcome
D002121:Calcium Channel Blockers; D000451:Mineralocorticoid Receptor Antagonists; D017311:Amlodipine; D013148:Spironolactone; D000077545:Eplerenone; D003404:Creatinine