March 30, 2011Journal of Hypertension
A double-blind, randomized study comparing the antihypertensive effect of eplerenone and spironolactone in patients with hypertension and evidence of primary aldosteronism
Key result
Eplerenone was less effective than spironolactone in reducing diastolic blood pressure (difference -6.9 mmHg; 95% CI -10.6 to -3.3; P<0.001) in patients with primary aldosteronism.
Why the study?
Does eplerenone reduce seated DBP non-inferiorly to spironolactone in patients with hypertension and primary aldosteronism?
Population
Patients with hypertension associated with primary aldosteronism meeting biochemical criteria, with seated…
Comparison
Eplerenone 100-300 mg once daily for 16 weeks vs Spironolactone 75-225 mg once daily for 16 weeks
Design
RCT, 1:1, double-blind
Follow-up
16 weeks
Authors
Discussion
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Implication
Spironolactone should be preferred over eplerenone for BP control in primary aldosteronism; confirms its superiority in this RCT.
Study Design
Type
RCT
Blinding
Double-blind
Randomization
1:1
Multicenter
Yes
Structured PICO
Does eplerenone reduce seated DBP non-inferiorly to spironolactone in patients with hypertension and primary aldosteronism?
P
Population
Patients with hypertension associated with primary aldosteronism meeting biochemical criteria, with seated DBP 90-119 mmHg and SBP <200 mmHg.
I
Intervention
Eplerenone 100-300 mg once daily (titration-to-effect) for 16 weeks
C
Comparator
Spironolactone 75-225 mg once daily (titration-to-effect) for 16 weeks
O
Outcome
Mean change from baseline in seated DBP at 16 weeks (to establish noninferiority)surrogate
Main Result
Effect estimate: Difference -6.9 mmHg (95% CI -10.6, -3.3)
Absolute Event Rate: -5.6% vs -12.5%
p-value: p=<0.001
Spironolactone provides significantly greater blood pressure reduction than eplerenone in patients with primary aldosteronism, though it is associated with higher rates of sex-hormone-related side effects.
Cite This Study
Parthasarathy et al. (2011) conducted an RCT in Hypertension associated with primary aldosteronism. Eplerenone vs. Spironolactone (75-225 mg once daily) was evaluated on Mean change from baseline in seated DBP to establish noninferiority (Difference -6.9 mmHg, 95% CI -10.6, -3.3, p=<0.001). Eplerenone was less effective than spironolactone in reducing diastolic blood pressure (difference -6.9 mmHg; 95% CI -10.6 to -3.3; P<0.001) in patients with primary aldosteronism.