Successful Add-on Therapy With Eplerenone

[Guest guest]

Successful Add-on Therapy With Eplerenone

Also at ESC Congress 2002, further evidence was presented of the

efficacy of the new selective aldosterone blocker, eplerenone, as

add-on therapy to existing antihypertensive medication in patients

with uncontrolled blood pressure.[3] Researchers from Belgium,

Germany, Slovakia, and the United States reported a multicenter, 8-

week study in 272 patients whose hypertension had not been

controlled by calcium channel blockers (CCBs) or beta-blockers.

These patients were randomized to receive either eplerenone 50 mg

once daily (uptitrated to 100 mg if necessary) or placebo in

addition to their current antihypertensive therapy. The addition of

eplerenone significantly reduced systolic blood pressure (SBP)

compared with placebo (mean: -17.2 vs -10.5 mm Hg, P < .001) in the

CCB group and yielded significant changes in both SBP and diastolic

blood pressure (DBP) (mean: -19.1/-12/3 vs -11.0/-8.8 mm Hg, P

< .001/0.008) in the beta-blocker group. In addition, patients who

took eplerenone had a significantly higher response rate than those

on placebo (75.4% vs 68.2%, P = .002).

These data followed similar results from another recently published,

8-week, international multicenter study in which 341 patients whose

blood pressure was not controlled on an angiotensin-converting

enzyme (ACE) inhibitor or an ARB were similarly randomized to

eplerenone or placebo.[4] In this trial, the addition of eplerenone

resulted in significant reductions in SBP in both the ACE and ARB

groups compared with placebo (mean: -13.4 vs -7.5 mm Hg and -16.0

vs -9.2 mm Hg, respectively) and a significant reduction in DBP in

the ARB group only (-12.7 vs -9.3 mm Hg). Adverse events in both

studies were generally nonsevere, and no

antiandrogenic/progestational effects occurred.

The researchers acknowledge that the issue of whether the additional

reduction in blood pressure produced by selective aldosterone

blockade confers further cardiovascular benefits remains unresolved

and cannot be assessed in as short a period as 8 weeks. However,

they point out that recent studies of eplerenone plus enalapril have

suggested an additive effect on surrogate markers of end-organ

damage, such as echocardiographic parameters of LVH and

microalbuminuria in diabetic patients.[5,6]

From the article:

Hypertension Update

Revisiting the Debate: Are All Antihypertensive Agents Created Equal?

http://www.medscape.com/viewarticle/441616