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Aldosterone receptor antagonists: focus on eplerenone
1AstraZeneca LP, 725 Chesterbrook Boulevard, Wayne, PA 19087, USA. robert.lamb@astrazeneca.com
Insights
Inadequate blood pressure control highlights the need for new hypertension treatments. Aldosterone antagonism, particularly with eplerenone, offers a promising strategy for improved hypertension management.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- Despite existing hypertension guidelines, blood pressure control remains suboptimal in the general population.
- Hypertension pathophysiology involves alterations in cardiac output and peripheral resistance, often linked to the renin-angiotensin-aldosterone system.
- Current treatments like ACE inhibitors and ARBs do not fully block aldosterone production.
Purpose of the Study:
- To review the renin-angiotensin-aldosterone system.
- To emphasize the role of aldosterone antagonism in hypertension management.
- To focus on the therapeutic application of eplerenone.
Main Methods:
- Literature review of the renin-angiotensin-aldosterone system.
- Analysis of aldosterone's role in hypertension.
- Summary of eplerenone's mechanism and clinical use.
Main Results:
- Aldosterone plays a significant role in hypertension, even with current therapies.
- Selective aldosterone receptor antagonists like eplerenone provide a targeted approach.
- Eplerenone is approved for hypertension treatment, alone or with other agents.
Conclusions:
- Aldosterone antagonism represents a valuable therapeutic avenue for hypertension.
- Eplerenone offers a new option for enhancing blood pressure control.
- Further re-evaluation of treatment strategies is crucial for effective hypertension management.
Abstract:
Despite the development of hypertension treatment guidelines, blood pressure control in the general population remains inadequate, indicating the need for ongoing re-evaluation of treatment strategies to further improve blood pressure control. Hypertension results from alterations in cardiac output and/or peripheral resistance. The renin-angiotensin-aldosterone system may be responsible, at least in part, for these alterations. Despite pharmacologic intervention with angiotensin-converting enzyme inhibitors and angiotensin type-1 receptor antagonists, aldosterone continues to be produced. Therapeutic modalities for treating hypertension directed toward antagonizing aldosterone might more effectively control blood pressure. Eplerenone, a new selective aldosterone receptor antagonist, recently received approval from the US Food and Drug Administration for the treatment of hypertension, either alone or in combination with other antihypertensive agents. The objective of this review is to summarize the renin-angiotensin-aldosterone system, emphasizing the role for aldosterone antagonism in the management of hypertension, with a focus on eplerenone.