Effects of drospirenone/17-beta estradiol on blood pressure and potassium balance in hypertensive postmenopausal women.
BACKGROUND
Drospirenone (DRSP) is a novel progestin with aldosterone receptor antagonist activity developed for hormone therapy as DRSP /17-beta estradiol (DRSP/E2). Because of a significant aldosterone antagonist activity, we studied the effects of DRSP/E2 on serum potassium (K) and blood pressure (BP) in hypertensive postmenopausal women with and without diabetes mellitus.


METHODS
This was a multicenter trial in postmenopausal women 44 to 70 years of age, either with type 2 diabetes mellitus (n = 82) or without type 2 diabetes mellitus (n = 148) and using an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor antagonist. Patients were randomized to 28 days of DRSP/E2 or placebo. Study endpoints were the number and percentage subjects who developed hyperkalemia (K >or= 5.5 mEq/L) and changes from baseline in clinic systolic and diastolic BP. To increase the likelihood of unmasking hyperkalemia, the nondiabetic group was also administered ibuprofen for 5 days.


RESULTS
There were no statistical differences in the overall number and percentage of subjects with hyperkalemia for DRSP/E2 versus placebo. No subject had symptoms or electrocardiographic changes related to hyperkalemia. Blood pressure was reduced by -8.6/-5.8 mm Hg in patients receiving DRSP/E2 versus -3.7/-2.9 mm Hg in those receiving placebo (P < .01 for both SBP and DBP).


CONCLUSIONS
In hypertensive postmenopausal women, treatment with DRSP/E2 was not associated with a greater incidence of hyperkalemia than with placebo in patients with and without type 2 diabetes mellitus and concomitant use of ACE inhibitors, angiotensin receptor antagonists, or ibuprofen. Furthermore, DRSP/E2 was found to have a significant antihypertensive effect in this high-risk population.
Preston
Richard A
RA
Division of Clinical Pharmacology and Pharmacokinetics Clinical Research Center, Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA. rpreston@med.miami.edu
White
William B
WB
Pitt
Bertram
B
Bakris
George
G
Norris
Paul M
PM
Hanes
Vladimir
V
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000736:Androstenes / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy*; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D015663:Osteoporosis, Postmenopausal / Q000097:blood / Q000188:drug therapy*; D011188:Potassium / Q000097:blood*; D012449:Safety; D016896:Treatment Outcome
D000736:Androstenes; D000451:Mineralocorticoid Receptor Antagonists; D004958:Estradiol; C035144:drospirenone; D011188:Potassium