title: Effects of Add-on Therapy Consisting of a Selective Mineralocorticoid Receptor Blocker on Arterial Stiffness in Patients with Uncontrolled Hypertension.
abstract: OBJECTIVE
  Aldosterone plays an important role in the pathogenesis of atherosclerosis; however, the significance of mineralocorticoid receptor blockade for atherosclerosis has not been fully elucidated. In this study, the effect of add-on eplerenone on the degree of arterial stiffness was examined in patients with uncontrolled hypertension.
  
  
  METHODS
  Forty-seven uncontrolled hypertensive patients who had previously been treated with anti-hypertensive drugs were examined retrospectively. Thirty-two patients received add-on therapy consisting of eplerenone (Group E) and 15 patients received add-on therapy with a Calcium channel blocker (CCB) or an increased dose of CCB (Group C) in addition to their baseline medications. Both the systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were significantly decreased at two and 12 months in Group C. In contrast, neither the SBP nor DBP values were significantly changed at two months and eventually decreased at 12 months in Group E. The degree of arterial stiffness, as evaluated according to the cardio-ankle vascular index (CAVI), did not improve at either two or 12 months in Group C, whereas the CAVI values improved as early as at two months and the improvement was sustained at 12 months in Group E. The extent of change in the CAVI was not associated with the level of changes in the SBP or DBP values in Group E.
  
  
  CONCLUSIONS
  Treatment with eplerenone added to the patient's baseline medications improves the degree of arterial stiffness as early as at two months after the beginning of treatment, independent of the blood pressure-lowering actions of these drugs in patients with uncontrolled hypertension.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The Jikei Daisan Hospital, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shibata
authors.forename: Joshi
authors.initials: J
authors.lastname: Tsutsumi
authors.forename: Jun
authors.initials: J
authors.lastname: Hasegawa
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Sato
authors.forename: Eitatsu
authors.initials: E
authors.lastname: Murashima
authors.forename: Chikara
authors.initials: C
authors.lastname: Mori
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hongo
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshimura
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D000077545:Eplerenone; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D018161:Receptors, Mineralocorticoid / Q000627:therapeutic use*; D012189:Retrospective Studies; D013148:Spironolactone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome; D059289:Vascular Stiffness / Q000187:drug effects*
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D018161:Receptors, Mineralocorticoid; D013148:Spironolactone; D000077545:Eplerenone