The velocity of home blood pressure reduction in response to low-dose eplerenone combined with other antihypertensive drugs determined by exponential decay function analysis

Elnagar, Noha; Satoh, Michihiro; Miki, Hirokazu; Asayama, Kei; Ishikura, Kazuki; Obara, Taku; Mano, Nariyasu; Imai, Yutaka

doi:10.3109/10641963.2014.892117

Cited by 4 publications

(2 citation statements)

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“…Williams and colleagues recently reported in the Optimum Treatment for Drug‐Resistant Hypertension (PATHWAY‐2) study that spironolactone was effective in lowering home BP in 314 patients with RH. There have been only two studies that examined the effect of eplerenone on home BP (but not in RH): one was a retrospective study of 83 hypertensive patients with 8 weeks of eplerenone treatment wherein home SBP/DBP decreased by −7.1±10.1/−2.6±5.0 mm Hg ( P <.0001), but this was a single‐arm study. The other study compared the efficacy of add‐on eplerenone and add‐on indapamide on home BP and showed that eplerenone (−10±10/−4±6 mm Hg) and indapamide (−15±10/−7±6 mm Hg) were equally effective in lowering home BP .…”

Section: Discussionmentioning

confidence: 99%

Add‐On Use of Eplerenone Is Effective for Lowering Home and Ambulatory Blood Pressure in Drug‐Resistant Hypertension

Eguchi

Kabutoya

Hoshide

et al. 2016

J of Clinical Hypertension

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2The authors aimed to investigate the blood pressure (BP)-lowering ability of eplerenone in drug-resistant hypertensive patients. A total of 57 drug-resistant hypertensive patients whose home BP was ≥135/85 mm Hg were investigated. The patients were randomized to either an eplerenone group or a control group and followed for 12 weeks. The efficacy was evaluated by clinic, home, and ambulatory BP monitoring. Urinary albumin, pulse wave velocity, and flowmediated vasodilation (FMD) were also evaluated. Home morning systolic BP (148AE15 vs 140AE15 mm Hg) and evening systolic BP (137AE16 vs 130AE16 mm Hg) were significantly lowered in the eplerenone group (n=35) compared with baseline (both P<.05), while unchanged in the control group (n=22). BP reductions in the eplerenone group were most pronounced for ambulatory awake systolic BP (P=.04), awake diastolic BP (P=.004), and 24-hour diastolic BP (P=.02). FMD was significantly improved in the eplerenone group. In patients with drug-resistant hypertension, add-on use of eplerenone was effective in lowering BP, especially home and ambulatory awake BP. J Clin Hypertens (Greenwich). 2016;18:1250-1257. ª 2016 Wiley Periodicals, Inc.Resistant hypertension (RH) is defined as failure to attain a target clinic blood pressure (BP) level <140/ 90 mm Hg despite treatment with at least three antihypertensive classes including at least one diuretic.1,2 RH is frequently seen in clinical practice and is often difficult to manage. It is important to uncover the factors that could make patients drug-resistant, including white-coat RH, substances that elevate BP, insufficient drug regimen, and secondary hypertension such as sleep apnea. After confirming that patients are truly drug-resistant, clinicians should refer them to hypertension specialists to consider improvement in medical regimens or enhancement of lifestyle modification in order to achieve better BP control. 3Mineralocorticoid receptor antagonists, especially spironolactone, have been established as drug regimens in the management of RH.4,5 A selective mineralocorticoid receptor antagonist, eplerenone, has also been shown to be effective in patients with RH, 6 but it has not been established whether this agent is effective in lowering different types of BP, such as clinic, home, and ambulatory BP. In addition, the effect of eplerenone on the measures of target organ damage (TOD) in patients with RH has not been assessed. In the present study, we sought to test the hypothesis that additional use of eplerenone could lower various measures of BP and improve the measures of TOD in patients with drugresistant hypertension who were already treated with at least three antihypertensive drugs, including calcium channel blockers (CCBs), renin-angiotensin system (RAS) inhibitors, and diuretics. METHODSThe inclusion criteria in this study were: (1) patients with essential hypertension who were classified as having drug-resistant hypertension treated with at least three antihypertensive drugs (CCBs, RAS inhibitors, and diuretics) for mor...

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Section: Discussionmentioning

confidence: 99%

Add‐On Use of Eplerenone Is Effective for Lowering Home and Ambulatory Blood Pressure in Drug‐Resistant Hypertension

Eguchi

Kabutoya

Hoshide

et al. 2016

J of Clinical Hypertension

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“…While the authors have described this time index previously, in this article, they evaluate seven different AT1 blockers, all used at medium dosage as monotherapy in patients referred to a specialist clinic for hypertension [16,17]. The drugs were compared in relation to the magnitude of the BP-lowering effect and the rapidity with which this maximum effect was achieved.…”

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confidence: 99%

Comparing the therapeutic merits of angiotensin receptor blockers

O’Brien¹

2016

Journal of Hypertension

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See original paper on page 1218 S uccessful control of blood pressure (BP) remains suboptimal in many jurisdictions [1]. Although there are many reasons for this, the considerable prevalence of hypertension is a challenge [2]. More than one quarter of adults in Western populations have high BP. In addition to being the leading attributable risk factor for death throughout the world, hypertension results in substantial illness due to its effect on several target organs, including the brain, eyes, heart, arteries, and kidneys [3][4][5][6]. It is the most common reason for a consultation at primary care level in which the majority of its management takes place. In addition to nonpharmacologic interventions, most individuals require antihypertensive medication to lower BP and often require them in combination. An understanding of the mode of action and complementary features of differing BP medications is important. The greater use of 'out of office' measurements highlights the need to use medications that offer good 24-h BP control and possibly have a complementary effect on indices, such as BP variability and the morning surge [7-10].Although lifestyle modification is important in hypertension management, most hypertensive individuals require more than two antihypertensive drugs to reduce their BP and maintain it within acceptable ranges [11][12][13]. The effectiveness of at least five classes of drugs used in treating hypertension and preventing cardiovascular events is well documented [12]. Yet there are differences in the therapeutic characteristics of medications within BP lowering classes [14]. The most commonly used medications among the many choices in antihypertensive therapy are those aimed at inhibiting the renin-angiotensin-aldosterone system.In this issue of Journal of Hypertension, there is an interesting article from Satoh and colleagues [15] evaluating a number of therapeutic characteristics of AT1 blockers, including 'velocity of maximal effect' or stabilization time, by which is meant the time interval from starting the medication to when it has its maximal effect. While the authors have described this time index previously, in this article, they evaluate seven different AT1 blockers, all used at medium dosage as monotherapy in patients referred to a specialist clinic for hypertension [16,17]. The drugs were compared in relation to the magnitude of the BP-lowering effect and the rapidity with which this maximum effect was achieved. The velocity or stabilization time based on morning home-BP readings differed significantly within the drug class. The magnitude of effect also varied, and Fig. 2 in Satoh et al. [15] might assist clinicians in their medication selection and follow-up of patients. The extent of BP-lowering effects of azilsartan was significantly greater than that of valsartan or irbesartan. The stabilization time of losartan based on home-SBP was significantly longer than that of azilsartan, valsartan, or irbesartan [15]. The authors suggest that clinicians should be aware of these varyi...

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The impact of clinical inertia on uncontrolled blood pressure in treated hypertension: real-world, longitudinal data from Japan

Satoh,

Muroya,

Murakami

et al. 2023

Hypertens Res

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The velocity of home blood pressure reduction in response to low-dose eplerenone combined with other antihypertensive drugs determined by exponential decay function analysis

Abstract: Our data suggest that the combination of eplerenone with other antihypertensive drugs may be a promising therapeutic strategy for the treatment of essential hypertension.

Cited by 4 publications

References 33 publications

Add‐On Use of Eplerenone Is Effective for Lowering Home and Ambulatory Blood Pressure in Drug‐Resistant Hypertension

Add‐On Use of Eplerenone Is Effective for Lowering Home and Ambulatory Blood Pressure in Drug‐Resistant Hypertension

Comparing the therapeutic merits of angiotensin receptor blockers

The impact of clinical inertia on uncontrolled blood pressure in treated hypertension: real-world, longitudinal data from Japan

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