Eplerenone in hypertension.
Appreciation of the role of aldosterone in cardiovascular and renal disease has increased in the last 50 years. The use of spironolactone was limited by adverse sexual effects, including gynaecomastia. Eplerenone is a newer aldosterone antagonist that is much more selective, with minimal affinity for progesterone and androgenic receptors; therefore, there are very few reports of adverse sexual effects. A review of published trials shows that eplerenone reduces blood pressure (BP) in a dose-dependent manner, from 50 to 200 mg/day, and to a similar degree as enalapril. It has an additive effect when given to patients inadequately controlled on an angiotensin-converting enzyme inhibitor or an angiotensin-receptor blocker. Eplerenone performs better than losartan in African-American patients and lowers BP regardless of initial plasma renin activity. The risk of hyperkalaemia is low, similar to that of enalapril, and < 1% of patients have had to be withdrawn from studies because of elevated serum potassium levels. Eplerenone is an effective, well-tolerated antihypertensive agent that may be used alone or in conjunction with other agents; apart from the risk of hyperkalaemia, adverse effects are similar to placebo.
Burgess
Ellen
E
University of Calgary, Department of Medicine, Faculty of Medicine, 2500 University Drive NW, Calgary, Alberta, T2N 1N4 Canada. Ellen.Burgess@CalgaryHealthRegion.ca
D017311:Amlodipine / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002986:Clinical Trials as Topic; D004656:Enalapril / Q000627:therapeutic use; D000077545:Eplerenone; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D013148:Spironolactone / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000959:Antihypertensive Agents; D017311:Amlodipine; D013148:Spironolactone; D000077545:Eplerenone; D004656:Enalapril