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Effects of eplerenone, enalapril, and eplerenone/enalapril in patients with essential hypertension and left
Bertram Pitt1, Nathaniel Reichek, Roland Willenbrock
1University of Michigan Health System, Ann Arbor, Mich, USA. bpitt@umich.edu
Circulation
|October 1, 2003
Summary
Eplerenone effectively reduced left ventricular hypertrophy (LVH) similar to enalapril. The combination therapy showed superior LVH regression and blood pressure control in hypertensive patients.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Renin-angiotensin-aldosterone system (RAAS) activity is linked to left ventricular hypertrophy (LVH) and cardiovascular risk.
- The distinct roles of angiotensin II and aldosterone in LVH progression require further elucidation.
- This study investigates LVH regression using selective aldosterone blockade versus angiotensin-converting enzyme inhibition.
Purpose of the Study:
- To compare the efficacy of eplerenone, enalapril, and their combination in regressing left ventricular hypertrophy (LVH) in hypertensive patients.
- To assess the impact of these treatments on blood pressure control and RAAS hormone levels.
- To evaluate the safety and tolerability profiles of the different treatment regimens.
Main Methods:
- A 9-month, double-blind, randomized trial involving 202 hypertensive patients with LVH.
- Patients received eplerenone, enalapril, or a combination of both, with add-on therapy as needed for blood pressure control.
- Left ventricular (LV) mass changes, assessed by MRI, served as the primary endpoint; blood pressure, hormone levels, and safety were also monitored.
Main Results:
- Eplerenone demonstrated comparable LVH regression to enalapril (-14.5g vs. -19.7g, P=0.258).
- The combination of eplerenone and enalapril achieved greater LVH regression (-27.2g) compared to eplerenone monotherapy (P=0.007).
- All treatments effectively reduced systolic and diastolic blood pressure; cough was more frequent with enalapril, and hyperkalemia with eplerenone.
Conclusions:
- Eplerenone is as effective as enalapril for LVH regression and blood pressure management in hypertension.
- Combination therapy with eplerenone and enalapril offers enhanced benefits for LVH reduction and systolic blood pressure control.
- Selective aldosterone blockade presents a viable therapeutic option for hypertensive patients with LVH.
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