Effects of a selective aldosterone blocker and thiazide-type diuretic on blood pressure and organ damage in hypertensive patients

Ohta, Yuko; Ishizuka, Azusa; Hayashi, Shinichiro; Iwashima, Yoshio; Kishida, Masatsugu; Yoshihara, Fumiki; Nakamura, Satoko; Kawano, Yuhei

doi:10.3109/10641963.2015.1026041

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…There have been only two studies that examined the effect of eplerenone on home BP (but not in RH): one was a retrospective study of 83 hypertensive patients with 8 weeks of eplerenone treatment wherein home SBP/DBP decreased by −7.1±10.1/−2.6±5.0 mm Hg ( P <.0001), but this was a single‐arm study. The other study compared the efficacy of add‐on eplerenone and add‐on indapamide on home BP and showed that eplerenone (−10±10/−4±6 mm Hg) and indapamide (−15±10/−7±6 mm Hg) were equally effective in lowering home BP . On the other hand, low‐dose spironolactone was shown to be effective in lowering home BP .…”

Section: Discussionmentioning

confidence: 99%

“…The other study compared the efficacy of add-on eplerenone and add-on indapamide on home BP and showed that eplerenone (À10AE10/À4AE6 mm Hg) and indapamide (À15AE10/À7AE6 mm Hg) were equally effective in lowering home BP. 21 On the other hand, low-dose spironolactone was shown to be effective in lowering home BP. 22 Because ambulatory BP assesses only 1-day BP, the additional confirmation of BP-lowering effects by home BP monitoring could provide a more robust assessment of BP lowering.…”

Section: Eplerenone and Ambulatory And Home Bpmentioning

confidence: 99%

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

Eguchi

Kabutoya

Hoshide

et al. 2016

J of Clinical Hypertension

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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...

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Section: Discussionmentioning

confidence: 99%

Section: Eplerenone and Ambulatory And Home Bpmentioning

confidence: 99%

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

Eguchi

Kabutoya

Hoshide

et al. 2016

J of Clinical Hypertension

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“…MRAs even outperform other diuretics in improving arterial stiffness [72]. Their beneficial effects extend to endothelium-dependent flow-mediated vasodilatation [73], likely due to the role of MR in the modulation of endothelial stiffness and function [51,74,75•], and to highly specialised vascular beds such as coronary circulation [76,77].…”

Section: Would Targeting Tissue Na + Improve Resistance?mentioning

confidence: 99%

Does Excess Tissue Sodium Storage Regulate Blood Pressure?

Rossitto

Delles

2022

Curr Hypertens Rep

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Purpose of Review The regulation of blood pressure is conventionally conceptualised into the product of “circulating blood volume” and “vasoconstriction components”. Over the last few years, however, demonstration of tissue sodium storage challenged this dichotomous view. Recent Findings We review the available evidence pertaining to this phenomenon and the early association made with blood pressure; we discuss open questions regarding its originally proposed hypertonic nature, recently challenged by the suggestion of a systemic, isotonic, water paralleled accumulation that mirrors absolute or relative extracellular volume expansion; we present the established and speculate on the putative implications of this extravascular sodium excess, in either volume-associated or -independent form, on blood pressure regulation; finally, we highlight the prevalence of high tissue sodium in cardiovascular, metabolic and inflammatory conditions other than hypertension. Summary We conclude on approaches to reduce sodium excess and on the potential of emerging imaging technologies in hypertension and other conditions.

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“…Previous clinical studies reported that eplerenone significantly reduced urinary albumin compared with amlodipine or enalapril, 19 but only a few studies have investigated its effect on albuminuria by comparison with thiazide diuretics. 29 The lack of clinical data on eplerenone may have been because of restriction of its administration for patients with diabetic nephropathy with overt proteinuria and patients with chronic kidney disease with moderate or severe renal dysfunction.…”

Section: Ras Inhibitors (Angiotensin-converting Enzyme Inhibitor or Arb)mentioning

confidence: 99%

Antialbuminuric effect of eplerenone in comparison to thiazide diuretics in patients with hypertension

Sawai

Dohi

Fujimoto

et al. 2017

J of Clinical Hypertension

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This study investigated the effects and safety of eplerenone or thiazide diuretics in patients with hypertension and albuminuria (pretreatment urinary albumin/creatinine ratio ≥10 mg/gCr) treated with an angiotensin II receptor blocker . The primary end point was the mean percent change in the urinary albumin/creatinine ratio from baseline to 48 weeks. An efficacy analysis was performed in 195 patients (98 in the eplerenone group and 97 in the thiazide group). Systolic and diastolic blood pressures at 48 weeks were similar in the two groups. The mean percent change in the urinary albumin/creatinine ratio from baseline to 48 weeks was similar in the two groups (P=.804). In the safety analysis, the withdrawal rates for adverse events were similar in both groups. The antialbuminuric effects and safety of eplerenone therapy were similar to those of thiazide diuretics when combined with an angiotensin II receptor blocker in patients with hypertension and albuminuria.

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Effects of a selective aldosterone blocker and thiazide-type diuretic on blood pressure and organ damage in hypertensive patients

Cited by 7 publications

References 20 publications

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

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

Does Excess Tissue Sodium Storage Regulate Blood Pressure?

Antialbuminuric effect of eplerenone in comparison to thiazide diuretics in patients with hypertension

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