Antihypertensive and prognosis-modifying effects of eplerenone in the treatment of arterial hypertension


  • V. Nikolaienko



cardiovascular diseases, arterial hypertension, hyperaldosteronism, acute myocardial infarction, chronic heart failure, cardiovascular mortality, inhibitors of mineralocorticoid receptors, selective aldosterone receptor antagonists, eplerenone, Epletor


The article deals with the prospects of using eplerenone — a selective aldosterone receptor antagonist — for the treatment of patients with various degrees of arterial hypertension. A growing volume of clinical studies indicates that the multidirectional effects of eplerenone — antihypertensive, vaso-, reno-and cardioprotective, antithrombotic ones — enable to reduce blood pressure effectively, in particular, in patients with resistant hypertension, to prevent the development and progression of organ damage, to decrease the risk of total and cardiovascular mortality, to improve the quality of life and to increase its duration in patients with arterial hypertension.


Кваша О.О., Малацківська О.В. Внесок артеріальної гіпертензії в смертність населення // Новости медицины и фармации. Артериальная гипертензия (тематический номер). — 2007. — 216.

Артеріальна гіпертензія. Оновлена та адаптована клінічна настанова, заснована на доказах. — 2012.

Pitt B., Ahmed A., Love T.E. et al. History of Hypertension and the Effects of Eplerenone in Patients with Acute Myocardial Infarction Complicated by Systolic Heart Failure // Hypertension. — 2008. — 52(2). — Р. 271-278. doi: 10.1161/HYPERTENSIONAHA.107.109314.

Pelliccia F., Patti G., Rosano G., Greco C., Gaudio C. Efficacy and safety of eplerenone in the management of mild to moderate arterial hypertension: systematic review and meta-analysis // Int. J. Cardiol. — 2014 Nov 15. — 177(1). — Р. 219-228. doi: 10.1016/j.ijcard.2014.09.091.

Takahashi S., Hiramatsu M., Hotta S. et al. Safety and Antihypertensive Effect of Selara® (Eplerenone): Results from a Postmarketing Surveillance in Japan // Int. J. Hypertens. — 2016. — Article ID 5091951, 9 pages Epub 2016 Oct 24.

Pitt B., Zannad F., Remme W.J. et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators // N. Engl. J. Med. — 1999. — 341. — Р. 709-717. doi: 10.1056/NEJM199909023411001

The RALES Investigators. Effectiveness of spironolactone added to an angiotensin-converting enzyme inhibitor and a loop diuretic for severe chronic congestive heart failure (the Rando-mized Aldactone Evaluation Study [RALES]) // Am. J. Car-

diol. — 1996. — 78. — Р. 902-907.

Yugar-Toledo J.C., Modolo R., de Faria A.P., Moreno H. Managing resistant hypertension: focus on mineralocorticoid-receptor antagonists // Vasc. Health Risk. Manag. — 2017 Oct 16. — 13. — Р. 403-411. doi: 10.2147/VHRM.S138599. eCollection 2017.

Stehr C.B., Mellado R., Ocaranza M.P. et al. Increased levels of oxidative stress, subclinical inflammation, and myocardial fibrosis markers in primary aldosteronism patients // J. Hypertens. — 2010 Oct. — 28(10). — Р. 2120-2126. doi: 10.1097/HJH.0b013e32833d0177.

Harada E., Yoshimura M., Yasue H. et al. Aldosterone induces angiotensin-converting-enzyme gene expression in cultured neonatal rat cardiocytes // Circulation. — 2001 Jul 10. — 104(2). — Р. 137-139.

Herrada A.A., Campino C., Amador C.A. et al. Aldosterone as a modulator of immunity: Implications in the organ da-mage // J. Hypertens. — 2011 Sep. — 29(9). — Р. 1684-92. doi: 10.1097/HJH.0b013e32834a4c75.

Kawasaki M., Yamada T., Okuyama Y. et al. Eplerenone might affect atrial fibrosis in patients with hypertension // Pa­cing and Clinical Electrophysiology. — 2017 October. — V. 40, Iss. 10. — P. 1096-1102.

Карабаева А.Ж. Минералокортикоидные рецепторы и альдостерон // Вестник ВГМУ. — 2008. — Т. 7, № 2. — С. 2-9.

Lainscak M., Pelliccia F., Rosano G. et al. Safety profile of mineralocorticoid receptor antagonists: Spironolactone and eplerenone // Int. J. Cardiol. — 2015 Dec 1. — 200. — Р. 25-29. doi: 10.1016/j.ijcard.2015.05.127. Epub 2015 May 21.

Rx idex® компендіум. Лікарські засоби для застосування в раціональній кардіології. — 2-ге вид., доп. та пер. — К., 2013. — С. 583-588.

Struthers A.D., Unger T. Physiology of aldosterone and pharmacology of aldosterone blockers // European Heart Journal. — 2012. — 33(22). — Р. 2782-2795.

Zhang Y. et al. Eplerenone restores 24-h blood pressure circadian rhythm and reduces advanced glycation end-products in rhesus macaques with spontaneous hypertensive metabolic syndrome // Sci. Rep. — 2016. — 6, 23957. doi: 10.1038/


Трошина А.А. Роль эплеренона в лечении кардиоваскулярной патологии // РМЖ «Медицинское обозрение». — 2017. — № 14. — С. 1073-1076

Danjuma M.I., Mukherjee I., Makaronidis J., Osula S. Converging indications of aldosterone antagonists (spironolactone and eplerenone): a narrative review of safety profiles // Curr. Hypertens. Rep. — 2014 Feb. — 16(2). — 414.

Гегенава Б.Б., Драпкина О.М. Селективный антагонист минералокортикоидных рецепторов эплеренон в кардиологической практике // Рациональная фармакотерапия в кардиологии. — 2015. — 11(2). — С. 177-181.

Tam T.S., Wu M.H., Masson S.C. et al. Eplerenone for hypertension// Cochrane Database Syst Rev. — 2017 Feb 28. — 2. — CD008996. doi: 10.1002/14651858.CD008996.pub2.

Gaddam K.K., Nishizaka M.K., Pratt-Ubunama M.N., Pimenta E., Aban I., Oparil S., Calhoun D.A. Characterization of resistant hypertension: association between resistant hypertension, aldosterone, and persistent intravascular volume expansion // Arch. Intern. Med. — 2008 Jun 9. — 168(11). — Р. 1159-64.

Brandani L. Resistant hypertension: a therapeutic challenge // J. Clin. Hypertens. — 2018. — V. 20, Iss. 1. — P. 76-78.

Spence J.D., Bogiatzi C., Kuk M. et al. Effects of Eplerenone on Resistance to Antihypertensive Medication in Patients with Primary or Secondary Hyperaldosteronism // J. Transl. Int. Med. — 2017 Jun. — 5(2). — Р. 93-99. doi: 10.1515/jtim-2017-0020

Oliveras A., Armario P., Clará A. et al. Spironolactone versus sympathetic renal denervation to treat true resistant hypertension: results from the DENERVHTA study: a randomized controlled trial // J. Hypertens. — 2016. — 34. — Р. 1863-

Eguchi K., Kabutoya T., Hoshide S., Ishikawa S., Kario K. Add-On Use of Eplerenone Is Effective for Lowering Home and Ambulatory Blood Pressure in Drug-Resistant Hypertension // J. Clin. Hypertens. (Greenwich). — 2016 Dec. — 18(12). — Р. 1250-1257. doi: 10.1111/jch.12860.

Pitt B., Zannad F. Eplerenone: is it time to add this drug to current heart failure therapy? //Ther. Adv. Chronic. Dis. — 2012 Jan. — 3(1). — Р. 5-9. doi: 10.1177/2040622311429891.

Ademi Z., Pasupathi K., Liew D. Cost-Effectiveness of Eplerenone Compared to Usual Care in Patients With Chronic Heart Failure and NYHA Class II Symptoms, an Australian Perspective // Medicine (Baltimore). — 2016 May. — 95(18). — e3531. doi: 10.1097/MD.0000000000003531.

Zhang Z., Mahoney E.M., Kolm P. et al. Cost effectiveness of eplerenone in patients with heart failure after acute myocardial infarction who were taking both ACE inhibitors and beta-blockers: subanalysis of the EPHESUS // Am. J. Cardiovasc. Drugs. — 2010. — 10(1). — Р. 55-63. doi: 10.2165/11319940-000000000-00000.

Mobaraki H., Azami-Aghdash S., Sarabi Asiabar A., Rezapour A., Kafaei Mehr M.H., Emamgolizadeh S. Cost-effectiveness of Eplerenone in treatment of cardiovascular diseases: a systematic review // Med. J. Islam. Repub. Iran. — 2017. — 31, 4. doi: 10.18869/mjiri.31.4.