Open AccessAldosterone Blockers (Mineralocorticoid Receptor Antagonism) and Potassium‐Sparing Diuretics
Author(s) -
Epstein Murray,
Calhoun David A.
Publication year - 2011
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/j.1751-7176.2011.00511.x
Subject(s) - spironolactone , eplerenone , medicine , hyperkalemia , mineralocorticoid receptor , aldosterone , thiazide , triamterene , hypokalemia , pharmacology , chlorthalidone , diuretic , hydrochlorothiazide , endocrinology , amiloride , hyperaldosteronism , blood pressure , sodium , chemistry , organic chemistry
J Clin Hypertens (Greenwich) . 2011;13:644–648. ©2011 Wiley Periodicals, Inc. Key Points and Practical Recommendations• Mineralocorticoid receptor (MR) antagonists (aldosterone blockers) provide effective antihypertensive treatment, especially in low‐renin and salt‐sensitive forms of hypertension, including resistant hypertension. • Newer, more selective MR antagonists (eg, eplerenone) have fewer of the progestational and antiandrogenic effects than spironolactone, enhancing tolerability and potentially improving adherence to therapy. • MR antagonists provide an additional benefit in the treatment of heart failure when combined with angiotensin‐converting enzyme inhibitors, digoxin, and loop diuretics. • Other potassium‐sparing diuretics (amiloride or triamterene) are generally prescribed for essential hypertension as a fixed‐dose combination with hydrochlorothiazide. • The dose range for spironolactone with resistant hypertension is between 25 mg/d and 50 mg/d, and eplerenone is an appropriate alternative if spironolactone is not tolerated because of sexual side effects. • In general, the combined use of spironolactone and adequate doses of a thiazide diuretic or a thiazide‐like agent such as chlorthalidone for the treatment of resistant hypertension maximizes efficacy and reduces the risk of spironolactone‐induced hyperkalemia.