Can Renin Status Predict the Antihypertensive Efficacy of Eplerenone Add‐On Therapy?

Since neither angiotensin‐converting enzyme inhibitors (ACE‐I) nor angiotensin II receptor blockers (ARB) can completely suppress aldosterone levels, there is a need for alternative/supplementary antihypertensive medications, such as the selective aldosterone blocker eplerenone (Inspra™). This multicenter study measured the safety and efficacy of add‐on eplerenone therapy to reduce blood pressure not controlled by ACE‐I or ARB monotherapy. An ad hoc analysis evaluated whether active plasma renin or serum aldosterone levels could predict blood pressure response to eplerenone therapy. Patients (N = 341) with a diastolic blood pressure > 95 mmHg on a fixed dose of ACE‐I or ARB were randomized to 8 weeks of double‐blind treatment with eplerenone 50 mg qd or placebo. If blood pressure remained uncontrolled following 2, 4, or 6 weeks of treatment, the eplerenone dose was increased to 100 mg qd. In a combined cohort analysis of these patients, the placebo‐adjusted change in systolic and diastolic blood pressure was −5.9/‐2.4 mmHg (p < 0.001 andp = 0.006, respectively). While adding eplerenone to an ACE‐I or ARB is safe and effective for blood pressure reduction, there was no baseline value or range of values of active plasma renin, serum aldosterone, or their ratio that predicted a favorable response to either of these drug combinations.