Low dose‐eplerenone treatment decreases aortic stiffness in patients with resistant hypertension

Vascular damage is aggravated in animal models of hypertension with mineralocorticoid ( MR ) excess and in hypertensive patients with primary hyperaldosteronism. MR antagonism has shown to provide effective blood pressure ( BP )‐control in patients with treatment resistant hypertension ( TRH ), but the concurrent effects on the vasculature have not been examined. In a randomized, double‐blinded, placebo‐controlled parallel‐group study, 51 patients with TRH received either eplerenone 50 mg or placebo for 6 months together with additional antihypertensives titrated to achieve a BP target of <140/90 mm Hg. Pulse wave velocity ( PWV ), augmentation index ( AI x), augmentation pressure ( AP ), AP normalized to a heart rate of 75/min ( AP @ HR 75), renal resistive index ( RRI ), intima‐media thickness ( IMT ) and urinary albumin excretion rate ( UAER ) were assessed before and after treatment. PWV was reduced only with eplerenone (from 11.3±3.6 to 9.8±2.6 m/s, P ˂.001), but not with placebo (10.3±2.0 to 10.1±1.8 m/s, P =.60), despite similar reductions in BP (−35±20/−15±11 mm Hg vs −30±19/−13±7 mm Hg, n.s.). Further, reductions in AP and AP @ HR 75 were greater with eplerenone, while changes in AI x, RRI , IMT and UAER were similar. Our data show that eplerenone beneficially affects markers of arterial stiffness and wave reflection in patients with TRH , independently of BP lowering. These data add to the evidence that MR antagonism should be the preferred treatment option in TRH .