Add-on eplerenone 50 mg daily significantly reduced ambulatory blood pressure from 141/87 to 132/83 mmHg at 3 months (P<0.001), with baseline systolic BP being the only predictor of response.
Cohort (n=117)
Does eplerenone 50 mg daily reduce blood pressure in patients with uncontrolled hypertension despite at least two antihypertensives?
Eplerenone 50 mg daily effectively lowers blood pressure in difficult-to-treat primary hypertension, with the magnitude of reduction predicted by baseline ambulatory systolic blood pressure rather than RAAS activity.
p-value: p=<0.001
BACKGROUND: Add-on therapy with aldosterone receptor antagonists has been reported to lower blood pressure (BP) in patients with uncontrolled hypertension. We assessed potential predictors of this response. METHODS: In essential hypertensive patients with uncontrolled BP, despite the use of at least two antihypertensives, plasma renin and aldosterone concentrations and the transtubular potassium gradient (TTKG) were measured. Patients were treated with eplerenone 50 mg daily on top of their own medication. The office and ambulatory BP response and biochemical changes were evaluated after 1 week and 3 months of treatment and 6 weeks after discontinuation. Potential predictors for the change in 24-h ambulatory BP were tested in a multivariate regression model. RESULTS: One hundred and seventeen patients with a mean age of 50.5 ± 6.6 years were included. Office BP decreased from 149/91 to 142/87 mmHg (P < 0.001) and ambulatory BP from 141/87 to 132/83 mmHg after 3 months of treatment (P < 0.001). Six weeks after discontinuation of eplerenone, office and ambulatory BP measurements returned to baseline values. Treatment resulted in a small rise in serum potassium and creatinine, and a small decrease in the TTKG. In a multivariate model, neither renin, aldosterone, or their ratio, nor the TTKG predicted the BP response. Only baseline ambulatory SBP predicted the BP response, whereas the presence of left ventricular hypertrophy was associated with a smaller BP reduction. CONCLUSION: Add-on therapy with eplerenone effectively lowers BP in patients with difficult-to-treat primary hypertension. This effect is unrelated to circulating renin-angiotensin-aldosterone system activity and renal mineralocorticoid receptor activity as assessed by the TTKG.
Jansen et al. (Wed,) conducted a cohort in Uncontrolled essential hypertension (n=117). Eplerenone was evaluated on Change in 24-h ambulatory blood pressure (p=<0.001). Add-on eplerenone 50 mg daily significantly reduced ambulatory blood pressure from 141/87 to 132/83 mmHg at 3 months (P<0.001), with baseline systolic BP being the only predictor of response.