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About 1 in 100 people with hypertension have elevated levels of aldosterone; in these people, the antihypertensive effect of spironolactone may exceed that of complex combined regimens of other antihypertensives since it targets the primary cause of the elevated blood pressure.
Eplerenone is a newer drug that was developed as a spironolactone analog with reduced adverse effects. In addition to the y-lactone ring and the substituent on C-7, eplerenone has a 9α,11α-epoxy group. This group is believed to be the reason why eplerenone has a 20-40-fold lower affinity for the mineralocorticoid receptor than spironolactone. [7]
For mild blood pressure elevation, consensus guidelines call for medically supervised lifestyle changes and observation before recommending initiation of drug therapy. However, according to the American Hypertension Association, evidence of sustained damage to the body may be present even prior to observed elevation of blood pressure.
Eplerenone lowers blood pressure in patients with primary hypertension. [9] Eplerenone also reduces arterial stiffness and vascular endothelial dysfunction. [10] For persons with resistant hypertension, eplerenone is safe and effective for reducing blood pressure, [11] particularly in persons with resistant hypertension due to ...
For most people, recommendations are to reduce blood pressure to less than or equal to somewhere between 140/90 mmHg and 160/100 mmHg. [2] In general, for people with elevated blood pressure, attempting to achieve lower levels of blood pressure than the recommended 140/90 mmHg will create more harm than benefits, [3] in particular for older people. [4]
For people with resistant hypertension, already taking a thiazide diuretic, an angiotensin converting enzyme inhibitor (ACE-i) or an angiotensin II receptor blocker (ARB), and a calcium channel blocker, the addition of amiloride (or spironolactone) was better at reducing blood pressure than adding a beta-blocker or an alpha-1 blocker . [8]
[16] [17] In any case, if one or both of these actions are clinically relevant, they might contribute to the menstrual irregularities and breast side effects of spironolactone. [14] [18] Spironolactone is also an agonist of the pregnane X receptor, [19] and is able to induce the expression of CYP3A4 and P-glycoprotein in the body via this action.
The DASH diet reduced systolic blood pressure by 6 mm Hg and diastolic blood pressure by 3 mm Hg in patients with high normal blood pressure (formerly called "pre-hypertension"). Those with hypertension dropped by 11 and 6 mm Hg, respectively. These changes in blood pressure occurred with no changes in body weight.
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