Determinants of blood pressure reduction by eplerenone in uncontrolled hypertension

Pieter M. Jansen, Wijnanda J. Frenkel, Bert-Jan H. van den Born, Emile L. E. de Bruijne, Jaap Deinum, Michiel N. Kerstens, Joyce H. A. Arnoldus, Arend Jan Woittiez, Johanna A. M. Wijbenga, Robert Zietse, A. H. Jan Danser, Anton H. van den Meiracker*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

24 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)404-413
Number of pages10
JournalJournal of Hypertension
Volume31
Issue number2
DOIs
Publication statusPublished - Feb-2013

Keywords

  • aldosterone
  • eplerenone
  • hypertension
  • renin
  • transtubular potassium gradient
  • LOW-DOSE SPIRONOLACTONE
  • TRANSTUBULAR POTASSIUM CONCENTRATION
  • TO-RENIN RATIO
  • RESISTANT HYPERTENSION
  • REFRACTORY HYPERTENSION
  • ARTERIAL-HYPERTENSION
  • PRIMARY ALDOSTERONISM
  • CONTROLLED-TRIAL
  • EFFICACY
  • HYPERKALEMIA

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