Assessment of the novel selective aldosterone blocker eplerenone using ambulatory and clinical blood pressure in patients with systemic hypertension

White, William Β.; Carr, Albert A.; Krause, Scott; Jordan, Randy A.; Roniker, Barbara; Oigman, Wille

doi:10.1016/j.accreview.2003.08.049

Cited by 16 publications

(26 citation statements)

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“…Importantly, our study demonstrates that the antialbuminuric effect can be achieved readily with eplerenone (50 or 100 mg) and clearly is additive to the antialbuminuric effects of an ACE inhibitor. In contrast to the duration of effect of spironolactone (21), studies that used ambulatory BP monitoring demonstrated that eplerenone produces a sustained BP-lowering effect throughout a 24-h period (37). Consequently, the determination of BP at the end of the dosing interval in this study should not have an effect on our conclusion that there were no significant differences in BP between treatment regimens.…”

Section: Discussioncontrasting

confidence: 42%

Selective Aldosterone Blockade with Eplerenone Reduces Albuminuria in Patients with Type 2 Diabetes

Epstein

Williams

Weinberger

et al. 2006

Clinical Journal of the American Society of Nephrology

403

302

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Previous studies have shown that the selective aldosterone blocker eplerenone, in doses of up to 200 mg/d, reduces albuminuria in patients with type 2 diabetes. This study was conducted to ascertain whether lower doses of eplerenone (50 or 100 mg/d) co-administered with the angiotensin-converting enzyme (ACE) inhibitor enalapril would produce a similar antialbuminuric effect while obviating the hyperkalemia observed previously. After open-label run-in with enalapril 20 mg/d, patients with diabetes and a urinary albumin:creatinine ratio (UACR) >50 mg/g were randomly assigned to receive enalapril plus one of three double-blind daily treatments for 12 wk: placebo, eplerenone 50 mg (EPL50), or eplerenone 100 mg (EPL100). After week 4, amlodipine 2.5 to 10 mg/d was allowed for BP control (systolic/diastolic BP < 130/80 mmHg). The primary study end points were the percentage change from baseline at week 12 in UACR and the incidence of hyperkalemia. Secondary end points included percentage changes from baseline in UACR at weeks 4 and 8 and changes from baseline in systolic and diastolic BP. Treatment with EPL50 or EPL100 but not placebo significantly reduced albuminuria from baseline. By week 12, UACR was reduced by 7.4% in the placebo group, by 41.0% in the EPL50 group, and by 48.4% in the EPL100 group (both eplerenone groups, P < 0.001 versus placebo). The incidences of sustained and severe hyperkalemia were not significantly different in any of the three treatment arms and did not differ on the basis of quartile of estimated GFR (all NS). For the secondary end points, both eplerenone treatment groups significantly reduced albuminuria from baseline as early as week 4 (P < 0.001), whereas placebo treatment (including enalapril) did not result in any significant decreases in UACR. Systolic BP decreased significantly in all treatment groups at all time points, but, generally, all treatment groups experienced similar decreases in BP. Co-administration of EPL50 or EPL100 with an ACE inhibitor as compared with an ACE inhibitor alone significantly reduces albuminuria in patients with diabetes without producing significant increases in hyperkalemia.

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Section: Discussioncontrasting

confidence: 42%

Selective Aldosterone Blockade with Eplerenone Reduces Albuminuria in Patients with Type 2 Diabetes

Epstein

Williams

Weinberger

et al. 2006

Clinical Journal of the American Society of Nephrology

403

302

View full text Add to dashboard Cite

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“…Clinical research to date has shown that eplerenone when used alone or with other major antihypertensive drugs achieves excellent antihypertensive effects. [13][14][15][16][17][18][19][20] One of the intriguing properties of eplerenone is that its antihypertensive effect is not compromised in low-renin hypertensive patients, which means that it reduces blood pressure independently of the patient's renin profile. [14][15][16]26 This property makes eplerenone effective for Japanese patients who tend to have high salt intake.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, eplerenone is indicated for heart failure in 460 countries based on its anticipated beneficial cardiac effect. 7 It has been reported that eplerenone also has a stable antihypertensive effect, [13][14][15][16][17][18][19][20] with a profile slightly different from that of spironolactone, 21 and fewer adverse reactions, suggesting that it may become a first-line treatment for hypertension. However, clinical data on hypertensive patients in Japan are lacking for eplerenone.…”

Section: Introductionmentioning

confidence: 99%

Clinical effects of eplerenone, a selective aldosterone blocker, in Japanese patients with essential hypertension

Sato

Fukuda

2009

J Hum Hypertens

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“…It has been tested in patients with PA at doses from 50 to 300 mg/day in one or two daily doses (see below for details) (15,16). In patients with essential hypertension, there were no differences in side effects between eplerenone and placebo (14).…”

Section: Eplerenonementioning

confidence: 99%

“…Eplerenone differs from spironolactone in that its affinity for the progesterone and androgen receptors is 500-fold lower, no active metabolites have been identified, and its elimination half-life (4-6 h) is shorter (4,11). Eplerenone is given at doses of 25-50 mg/day to patients with cardiac failure (11,12), and at doses of 50-100 mg once or twice daily to patients with essential hypertension (13,14). It has been tested in patients with PA at doses from 50 to 300 mg/day in one or two daily doses (see below for details) (15,16).…”

Section: Eplerenonementioning

confidence: 99%

PROGRESS IN PRIMARY ALDOSTERONISM: Mineralocorticoid antagonist treatment for aldosterone-producing adenoma

Amar

Lorthioir

Azizi

et al. 2015

European Journal of Endocrinology

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Mineralocorticoid receptor antagonists have been used in patients with aldosterone-producing adenomas (APAs) as a test designed to predict the blood pressure (BP) outcome of surgery. They are commonly used in patients undergoing adrenalectomy to reduce BP and increase plasma potassium levels during the preoperative period. A small number of studies have compared the effects of surgery and mineralocorticoid antagonists either on BP, on serum potassium levels, or on the incidence of cardiovascular and renal outcomes in patients with primary aldosteronism with or without an APA; these studies found no difference between the two therapeutic options. Mineralocorticoid receptor antagonists can be used as a maintenance treatment for patients with APAs, who are judged to be poor operative risks or who do not want to undergo surgery.

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Assessment of the novel selective aldosterone blocker eplerenone using ambulatory and clinical blood pressure in patients with systemic hypertension

Cited by 16 publications

References 0 publications

Selective Aldosterone Blockade with Eplerenone Reduces Albuminuria in Patients with Type 2 Diabetes

Selective Aldosterone Blockade with Eplerenone Reduces Albuminuria in Patients with Type 2 Diabetes

Clinical effects of eplerenone, a selective aldosterone blocker, in Japanese patients with essential hypertension

PROGRESS IN PRIMARY ALDOSTERONISM: Mineralocorticoid antagonist treatment for aldosterone-producing adenoma

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