What does this research mean for the field?

Eplerenone therapy is more effective than trichlormethiazide therapy in lowering systolic blood pressure in overweight or obese hypertensive patients, particularly in those over 65 years of age, without significantly differing in its effects on glucose metabolism. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 1, 2019Open Access

Effects of eplerenone on blood pressure and glucose metabolism in Japanese hypertensives with overweight or obesity

Structured PICO

Does eplerenone improve blood pressure and glucose metabolism compared to trichlormethiazide in Japanese hypertensives with overweight or obesity?

Population

204 Japanese outpatients with hypertension and overweight or obesity (BMI ≥25 kg/m2), SBP ≥140 mm Hg and/or DBP ≥90 mm Hg despite antihypertensive medication. Mean age ~65 years, 51% male.

Intervention

Eplerenone 50 mg (titrated up to 100 mg/day if needed) oral once every morning for 6 months

Comparator

Trichlormethiazide 1 mg (titrated up to 2 mg/day if needed) oral once every morning for 6 months

Outcome

Change from baseline in office systolic and diastolic blood pressure, % change from baseline in insulin sensitivity (HOMA-IR), and % change from baseline in HbA1c after 24 weeks (6 months)surrogate

Eplerenone is more effective than trichlormethiazide for lowering systolic blood pressure in overweight or obese hypertensive patients, particularly those over 65, though it does not significantly improve glucose metabolism.

Abstract

OBJECTIVE: The impact of aldosterone blockade using eplerenone on hypertensives with obesity has not been clarified. We compared the efficacy and safety between eplerenone and trichlormethiazide in hypertensives with overweight or obesity. METHODS: A prospective, randomized, open-labeled, blinded-endpoint design, multicenter trial enrolled 204 hypertension-treated outpatients with obesity body mass index (BMI) ≥25 kg/m evaluated by ambulatory blood pressure (BP) measurement. Patients were randomly assigned to receive 50 mg of eplerenone (n = 102) or 1 mg of trichlormethiazide (n = 102), each of which were administered once every morning. Primary efficacy endpoints were systolic and diastolic BPs and biomarkers of glucose metabolism after 6 months of treatment. RESULTS: At baseline, BPs were comparable between the two groups. Systolic/diastolic blood pressure (SBP/DBP) were reduced from 153.9 ± 12.6/84.6 ± 11.8 to 129.8 ± 14.2/73.7 ± 12.2 mm Hg by eplerenone therapy and from 152.2 ± 12.5/85.2 ± 10.9 to 133.8 ± 12.6/76.1 ± 8.6 mm Hg by trichlormethiazide therapy (all; P < .001). The efficacy of SBP reduction after adjustment for age, sex, and BMI was significantly greater in the eplerenone group than the trichlormethiazide (P = .034), although the efficacy of DBP reduction was marginally significant (P = .072). Especially, the efficacy of BP reduction was more effective for aged over 65 years than less than 65 years. However, biomarkers of glucose metabolism were not significantly different between these 2 groups. CONCLUSION: The eplerenone therapy was more effective in BP lowering in hypertensives with overweight or obesity than the trichlormethiazide therapy, especially in the elderly.

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