Source: Hypertension  |  Posted 8 years ago

Eplerenone, a selective aldosterone blocker, is as effective as amlodipine, a calcium antagonist, in improving systolic blood pressure, pulse pressure and pulse wave velocity in older patients with systolic hypertension and widened pulse pressure.

In patients with microalbuminuria, eplerenone is more effective than is amlodipine at reducing the urinary albumin/creatinine ratio, investigators report.

The investigators, from multiple institutions including the University of Connecticut School of Medicine in Farmington, United States, compared eplerenone and amlodipine in 269 patients with systolic hypertension and widened pulse pressure. Patients were aged 50 years or older.

They were randomly assigned to receive either 50 to 200 milligrams eplerenone or 2.5 to 10 milligrams amlodipine daily in a double blind titration to effect design. Clinic blood pressure and pulse pressure were assessed in all patients, and ambulatory blood pressure, vascular compliance and urinary albumin secretion were assessed in a subset of patients.

Results showed that systolic blood pressure was reduced by similar amounts in both treatment groups after 24 weeks of therapy. The reduction was 20.5 ? 1.1 mm Hg in the eplerenone group and 20.1 ? 1.1 in the amlodipine group.

For diastolic blood pressure, amlodipine was somewhat more effective with a reduction of 6.9 mm Hg compared with a reduction of 4.5 mm Hg with eplerenone. Reductions in pulse pressure from baseline were also similar between the two groups, as were changes in pulse wave velocity.

Eplerenone reduced the urinary albumin/creatinine ratio by 52% in patients with microalbuminuria. Amlodipine treatment resulted in a 10% reduction.