Add‐On Use of Eplerenone Is Effective for Lowering Home and Ambulatory Blood Pressure in Drug‐Resistant Hypertension

Abstract

2The authors aimed to investigate the blood pressure (BP)-lowering ability of eplerenone in drug-resistant hypertensive patients. A total of 57 drug-resistant hypertensive patients whose home BP was ≥135/85 mm Hg were investigated. The patients were randomized to either an eplerenone group or a control group and followed for 12 weeks. The efficacy was evaluated by clinic, home, and ambulatory BP monitoring. Urinary albumin, pulse wave velocity, and flowmediated vasodilation (FMD) were also evaluated. Home morning systolic BP (148AE15 vs 140AE15 mm Hg) and evening systolic BP (137AE16 vs 130AE16 mm Hg) were significantly lowered in the eplerenone group (n=35) compared with baseline (both P<.05), while unchanged in the control group (n=22). BP reductions in the eplerenone group were most pronounced for ambulatory awake systolic BP (P=.04), awake diastolic BP (P=.004), and 24-hour diastolic BP (P=.02). FMD was significantly improved in the eplerenone group. In patients with drug-resistant hypertension, add-on use of eplerenone was effective in lowering BP, especially home and ambulatory awake BP. J Clin Hypertens (Greenwich). 2016;18:1250-1257. ª 2016 Wiley Periodicals, Inc.Resistant hypertension (RH) is defined as failure to attain a target clinic blood pressure (BP) level <140/ 90 mm Hg despite treatment with at least three antihypertensive classes including at least one diuretic.1,2 RH is frequently seen in clinical practice and is often difficult to manage. It is important to uncover the factors that could make patients drug-resistant, including white-coat RH, substances that elevate BP, insufficient drug regimen, and secondary hypertension such as sleep apnea. After confirming that patients are truly drug-resistant, clinicians should refer them to hypertension specialists to consider improvement in medical regimens or enhancement of lifestyle modification in order to achieve better BP control. 3Mineralocorticoid receptor antagonists, especially spironolactone, have been established as drug regimens in the management of RH.4,5 A selective mineralocorticoid receptor antagonist, eplerenone, has also been shown to be effective in patients with RH, 6 but it has not been established whether this agent is effective in lowering different types of BP, such as clinic, home, and ambulatory BP. In addition, the effect of eplerenone on the measures of target organ damage (TOD) in patients with RH has not been assessed. In the present study, we sought to test the hypothesis that additional use of eplerenone could lower various measures of BP and improve the measures of TOD in patients with drugresistant hypertension who were already treated with at least three antihypertensive drugs, including calcium channel blockers (CCBs), renin-angiotensin system (RAS) inhibitors, and diuretics. METHODSThe inclusion criteria in this study were: (1) patients with essential hypertension who were classified as having drug-resistant hypertension treated with at least three antihypertensive drugs (CCBs, RAS inhibitors, and diuretics) for mor...

Low dose‐eplerenone treatment decreases aortic stiffness in patients with resistant hypertension

“…The study by Eguchi and colleagues was able to demonstrate that eplerenone was more effective than placebo in patients with TRH, especially regarding reduction of home and ambulatory awake BP. 25 In addition to the BP reduction, this study also demonstrated an improvement in flowmediated vasodilation. 25 Similarly, in a prospective, randomized study Abbreviations: PWV, pulse wave velocity; SBP, systolic blood pressure.…”

“…25 In addition to the BP reduction, this study also demonstrated an improvement in flowmediated vasodilation. 25 Similarly, in a prospective, randomized study Abbreviations: PWV, pulse wave velocity; SBP, systolic blood pressure.…”

“…There are also some studies on eplerenone. The study by Eguchi and colleagues was able to demonstrate that eplerenone was more effective than placebo in patients with TRH, especially regarding reduction of home and ambulatory awake BP . In addition to the BP reduction, this study also demonstrated an improvement in flow‐mediated vasodilation .…”

Safety and Antihypertensive Effect of Selara® (Eplerenone): Results from a Postmarketing Surveillance in Japan

“…Furthermore, aldosterone, which exerts its activity in adipocytes, is involved in abnormal production/secretion of adipocytokines by adipocytes [21] and contributes to increases in oxidative stress [22] and decreases insulin sensitivity in adipose tissue [23, 24]. Eplerenone is thought to suppress the adverse effects of aldosterone in in various organs including the endothelium by inhibiting aldosterone activity through binding to MRs [25]; thus, eplerenone is a pharmacologically promising drug to prevent end organ damage induced by aldosterone.…”

Антигіпертензивні Та Прогноз-Модифікуючі Ефекти Еплеренону В Терапії Артеріальної Гіпертензії

“…Согласно результатам другого метаанализа, посвященного оценке возможностей монотерапии эплереноном при лечении пациентов с первичной АГ ( [26]. Снижение АД в группе эплеренона было наиболее выраженным для амбулаторного САД, ДАД после пробуждения и 24-часового ДАД.…”