title: A pilot study of the effects of eplerenone add-on therapy in patients taking renin-angiotensin system blockers.
abstract: OBJECTIVE
  This study determined the parameters for predicting the clinical effects of eplerenone (Ep) add-on therapy on blood pressure (BP) and proteinuria in patients taking angiotensin-converting enzyme inhibitors (ACEis) or angiotensin II type I receptor blockers (ARBs).
  
  
  METHODS
  Patients were treated with a gradual increase of Ep to a final dose of 50 mg/day for 2 months. In 35 patients, the efficacy of Ep was evaluated by peripheral BP, proteinuria, and the transtubular K gradient (TTKG). Fifteen patients had additional analysis for central BP, plasma renin activity (PRA) and plasma aldosterone concentration (PAC), measured in the supine position, and 24-hour urine collection before and after receiving Ep.
  
  
  RESULTS
  Ep add-on therapy reduced the mean arterial pressure (p=0.0005) and central BP (p=0.009) independently to the baseline PAC. Ep induced PRA, but failed to show effects on PAC, TTKG, or albuminuria. Correlation analysis showed inverse relationships between the percent reduction in albuminuria and baseline PAC.
  
  
  CONCLUSIONS
  Ep add-on therapy in patients taking renin-angiotensin system blockers is expected to reduce BP, even in patients with low PAC. In contrast, the anti-proteinuric action of Ep is dependent on baseline plasma aldosterone levels. TTKG is not appropriate for evaluating the efficacy of Ep.
authors: Health Care Center, Osaka University, Japan.
authors: Noritaka
authors: N
authors: Kawada
authors: Division of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Japan isaka@kid.med.osaka-u.ac.jp.
authors: Yoshitaka
authors: Y
authors: Isaka
authors: Division of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Japan.
authors: Harumi
authors: H
authors: Kitamura
authors: Division of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Japan.
authors: Hiromi
authors: H
authors: Rakugi
authors: Health Care Center, Osaka University, Japan.
authors: Toshiki
authors: T
authors: Moriyama
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D000450:Aldosterone / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D003971:Diastole / Q000187:drug effects; D000077545:Eplerenone; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012084:Renin-Angiotensin System / Q000187:drug effects*; D013148:Spironolactone / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D013599:Systole / Q000187:drug effects
chemical_list: D013148:Spironolactone; D000450:Aldosterone; D000077545:Eplerenone
keywords: Aldosterone; CBP; TTKG; albuminuria; eGFR