Physiologically individualised therapy based on renin/aldosterone profile Liddle phenotype (due Primary aldosteronism to variants of ENaC or genes affecting its function *) Renin Low Low Aldosterone High Low Primary Aldosterone antagonist Amiloride treatment (spironolactone or eplerenone
) Amiloride for men, where eplerenone
is not available (rarely surgery) Renal/renovascular Renin High Aldosterone High Primary Angiotensin receptor blocker treatment or renin inhibitor (rarely revascularisation) ENaC = renal tubular epithelial sodium channel.
Effect of polyvinyl caprolactam-polyvinyl acetate-polyethylene glycol graft copolymer on bioadhesion and release rate property of eplerenone
(46) established 3 groups of 20 patients with chronic CSCR (average duration of 8 months) and administered oral spironolactone to group 1, oral eplerenone
to group 2, and placebo to group 3 for the first month.
Mineralocorticoid receptor antagonists preferably eplerenone
are recommended to reduce the risk of cardiovascular hospitalization and death in patients with LVEF=40.
* Diuretic drugs, such as furosemide (Lasix[R]), bumetanide (Bumex[R]) or torsemide (Demadex[R]), as well as medications known as aldosterone receptor antagonists--examples include eplerenone
(Inspra[R]) and spironolactone (Aldactone[R])--which remove excess fluid.
The council advises that management of resistant hypertension includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), and addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone
The SHIFT (Systolic Heart Failure Treatment with the IF inhibitor Ivabradine Trial)  and the EMPHASIS-HF (Eplerenone
in mild patients with hospitalisation and survival study in heart failure) trials found that the pure heart rate-slowing agent Ivabradine and the mineralocorticoid receptor antagonist eplerenone
reduced all HF hospitalisations.
Some males treated with spironolactone can experience antiandrogen side effects with compromised sexual function and activity (e.g., decreased libido, ED, and gynecomastia), and eplerenone
may be reasonable alternative (55,56).
Daiichi Sankyo's application is based on the results of phase 3 studies including ESAX-HTN, a randomized, double-blind, three-arm parallel group comparison study evaluating the efficacy and safety of esaxerenone versus eplerenone
in patients with essential hypertension in Japan.
, magnesium oxide, and ketoconazole were also added.
The above mechanisms explain the results of EMPHASIS-HF trial: eplerenone
therapy was more beneficial for treatment of heart failure with reduced ejection fraction in patients with abdominal obesity [27, 28].
The mineralocorticoid receptor antagonists, spironolactone or eplerenone
, are currently approved for the management of heart failure and primary hypertension [21, 22].