Eplerenone Add on to Perindopril and Indapamide Improves Blood Pressure Control and Reversal of Cardiovascular Remodeling in High Risk Patients With Arterial Hypertension and Type

Objective: Patients with arterial hypertension and type 2 diabetes represent a population at very high cardiovascular risk, frequently requiring early treatment intensification. We investigated whether the addition of eplerenone to background therapy with perindopril and indapamide provides incremental blood pressure reduction and enhanced regression of cardiovascular remodeling over 12 months. Design and method: This prospective comparative 12-month study included elderly patients (n = 110) with arterial hypertension and type 2 diabetes; the mean age of the patients was 65 ± 12.3 years. The intensified treatment group received perindopril 8 mg plus indapamide 2.5 mg combined with eplerenone 25-50 mg daily. The standard treatment group received perindopril 8 mg plus indapamide 2.5 mg daily. Clinical and biochemical parameters were assessed at baseline and during follow up. Office and ambulatory blood pressure monitoring were performed. Echocardiography was used to calculate left ventricular mass index, and ultrasound examination assessed common carotid artery intima media thickness. Statistical significance was defined as p<0.05. Results: Both strategies significantly reduced systolic and diastolic blood pressure; however, the eplerenone based regimen achieved greater and earlier blood pressure control. Systolic blood pressure decreased by 40.3±7.4 mmHg in the intensified group versus 28.4±5.3 mmHg with standard therapy. Diastolic blood pressure declined by 22.5±4.7 mmHg versus 13.2±2.2 mmHg, respectively (p<0.05 for between group comparisons). Importantly, intensified therapy was associated with a markedly greater regression of target organ damage. Left ventricular mass index decreased by -15.5±2.9 g/m2 compared with - 5.3±1.8 g/m2 under standard treatment (p<0.05). Intima media thickness was reduced by - 0.32±0.12 mm versus - 0.20±0.11 mm (p<0.05). Treatment was well tolerated without clinically relevant safety concerns. Conclusions: In high risk patients with arterial hypertension and type 2 diabetes, addition of eplerenone to perindopril and indapamide provides superior blood pressure reduction and significantly enhances reversal of cardiac and vascular remodeling. These findings support early mineralocorticoid receptor blockade as a strategy to optimize organ protection beyond conventional dual therapy.