A double-blind, randomized study comparing the antihypertensive effect of eplerenone and spironolactone in patients with hypertension and evidence of primary aldosteronism

Parthasarathy, Hari K; Ménard, J; White, William Β.; Young, William F.; Williams, Gordon H.; Williams, Bryan; Ruilope, Luís M.; McInnes, Gordon T.; Connell, John; MacDonald, Thomas M.

doi:10.1097/hjh.0b013e3283455ca5

Cited by 227 publications

(130 citation statements)

References 35 publications

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“…However, one noticeable difference was the lower serum potassium level compared with the other treatment groups. In a recent study, hyperkalemia occurred more often in spironolactone than in eplerenone-treated patients (42). Therefore, we believe that the eplerenone doses used in our study might still be too low to effectively block the MR.…”

Section: Discussionmentioning

confidence: 71%

“…Considering previous studies, we are the first to investigate renal outcome depending on different therapeutic regimens in PA patients. Eplerenone is described to be as effective as spironolactone in reducing blood pressure in patients with BHA (41), whereas other studies claimed that the antihypertensive effect of spironolactone is significantly greater than that of eplerenone in PA patients (42). In the latter study, it was suggested that higher doses of eplerenone are needed to achieve the same effect as spironolactone.…”

Section: Discussionmentioning

confidence: 96%

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Effectiveness of eplerenone or spironolactone treatment in preserving renal function in primary aldosteronism

Fourkiotis

Vonend²,

Diederich³

et al. 2013

European Journal of Endocrinology

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Objective: Primary aldosteronism (PA) has deleterious effects on kidney function independent of blood pressure levels. Up to now, data on effectiveness of different PA therapies regarding renal function are scarce. Design and methods: This prospective multi-center study included 29 patients with newly diagnosed PA evaluated before and 1 year after treatment initiation, and a second cohort including 119 patients who were evaluated 5.3 and 6.8 years after treatment initiation. Glomerular filtration rate (GFR), spot urine albumin excretion/urinary creatinine (UAE/Ucrea) ratio, biochemical parameters, and 24-h blood pressure were measured. In a larger cross-sectional cohort, renal function was evaluated depending on the type of treatment (adrenalectomy (ADX; nZ86); spironolactone (nZ65); and eplerenone (nZ18)). Results: GFR and UAE/Ucrea ratio significantly decreased in newly diagnosed PA patients after treatment initiation. In the second cohort, GFR and UAE/Ucrea ratio did not change during study period, and blood pressure was well controlled. In the larger cross-sectional cohort, no differences were seen in GFR and UAE/Ucrea ratio between PA patients on different treatment regimens. However, eplerenone treatment showed lower potassium levels and higher number of required antihypertensive medications. Conclusions: Renal dysfunction with elevated albuminuria was seen in PA patients and was reversible after treatment initiation. Medical therapies with spironolactone or eplerenone seem to be as effective as ADX regarding renal function and blood pressure; however, sufficient daily doses need to be given.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 96%

Effectiveness of eplerenone or spironolactone treatment in preserving renal function in primary aldosteronism

Fourkiotis

Vonend²,

Diederich³

et al. 2013

European Journal of Endocrinology

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“…Parthasarathy et al [21] reported that the antihypertensive effects of spironolactone (from 75 to 225 mg) were significantly greater than those of eplerenone (from 100 to 300 mg) in 141 patients with PA including APAs. Two studies reported the adverse events associated with spironolactone treatment, which included gynecomastia, breast pain in females and impotence.…”

Section: Discussionmentioning

confidence: 99%

Comparison of eplerenone and spironolactone for the treatment of primary aldosteronism

et al. 2015

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“…68 However, double the dose is required to achieve an efficacy similar to that of spironolactone for lowering BP, and the ceiling effect appears to occur sooner: a 10 mmHg decreased in systolic BP at most, versus 25 mmHg for spironolactone. 69 Moreover, eplerenone must be administered twice daily to ensure activity throughout the day and is currently more expensive than spironolactone.…”

Section: Drug-based Treatment For Pamentioning

confidence: 99%

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

Steichen

Lorthioir

Zinzindohoué

et al. 2015

Advances in Chronic Kidney Disease

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Treatments for primary aldosteronism (PA) aim to correct or prevent the deleterious consequences of hyperaldosteronism: hypertension, hypokalemia and direct target organ damage. Patients with unilateral PA considered fit for surgery can undergo laparoscopic adrenalectomy, which significantly decreases blood pressure and medications in most cases, and cures hypertension in about 40%. Mineralocorticoid receptor antagonists (MRA) are used to treat patients with bilateral PA and those with unilateral PA if surgery is not possible or not desired. Spironolactone is more potent than eplerenone, but high doses are poorly tolerated in men. MRA can be replaced or complemented with epithelial sodium channel blockers, such as amiloride. Thiazide diuretics and calcium channel blockers are used when the first-line drugs are insufficient to control blood pressure. Dietary sodium restriction should be implemented in all cases, because the deleterious consequences of hyperaldosteronism are dependent on salt loading. Several studies comparing the results of surgery and MRA have reported no differences in terms of blood pressure, serum potassium concentration or cardiovascular and renal outcomes, although the benefits of treatment tend to be observed sooner with surgery.PA patients display relative glomerular hyperfiltration, which is reversed by specific treatment, revealing chronic kidney disease in 30% of patients. However, further kidney damage is prevented by the treatment of PA. Clinical summary-The goals of treatment are the normalization of serum potassium concentration, blood pressure control and prevention of the direct effects of excess aldosterone on target organs. 3-The non-surgical treatment of PA is based on mineralocorticoid receptor antagonists and dietary sodium restriction.-Epithelial sodium channel blockers are used when mineralocorticoid receptor antagonists are not well tolerated; thiazide diuretics and calcium channel blockers are used when blood pressure control is insufficient with the first-line treatment.-Laparoscopic adrenalectomy is safe and decreases BP and medication requirements in patients with unilateral PA; drug-based treatments are appropriate in cases in which surgery is inappropriate or not desired.

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A double-blind, randomized study comparing the antihypertensive effect of eplerenone and spironolactone in patients with hypertension and evidence of primary aldosteronism

Abstract: The antihypertensive effect of spironolactone was significantly greater than that of eplerenone in hypertension associated with primary aldosteronism.

Cited by 227 publications

References 35 publications

Effectiveness of eplerenone or spironolactone treatment in preserving renal function in primary aldosteronism

Effectiveness of eplerenone or spironolactone treatment in preserving renal function in primary aldosteronism

Comparison of eplerenone and spironolactone for the treatment of primary aldosteronism

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

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