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Objective:The objective of the present study was to evaluate the relationship between the presence or absence of aldosterone breakthrough and the blood pressure reduction, pulse wave velocity(PWV)reduction and left ventricular hypertrophy regression by eplerenone. Subjects and methods:The subjects were 34 naive hypertension patients who received no treatment at the time of initiation of the present study. Their early morning home blood pressure measurements after six month administration of angiotensin I I receptor blocker(ARB), either olmesartan(20 mg/day)or valsartan(80 mg/day), still exceeded 135/85 mmHg. Aldosterone breakthrough was defined as the condition in which plasma aldosterone concentration measured after six-month ARB administration was higher than that measured after one-month ARB administration. The patients were divided into the following two groups:breakthrough group(n=14)and non-breakthrough group(n=20). Eplerenone(50-100 mg/day)was additionally administered to the patients in these two groups for more than six months. The two groups were compared with each other with respect to early morning home blood pressure measurement, brachial-ankle(ba)PWV, and left ventricular mass index(LVMI). Results:The early morning home blood pressure reduction after ARB administration [systolic blood pressure(SBP)/diastolic blood pressure(DBP)]was-14.0±4.0/-10.8±7.0 mmHg in breakthrough group and -19.5±9.0/-12.3±4.4 mmHg in nonbreakthrough group. The SBP reduction in breakthrough group was significantly smaller than that in non-breakthrough group(p<0.05). The baPWV was 1874.5±243.0 cm/sec in breakthrough group and 1674.5±256.5 cm/sec in non-breakthrough group. The LVMI was 135.1±14.9 g/m2 in breakthrough group and 114.5±13.2 g/m2 in non-breakthrough group. Both baPWV and LVMI were significantly higher in breakthrough group than in non-breakthrough group(p<0.05). The early morning home blood pressure reduction after additional administration of eplerenone was -20.6±9.7/ -13.3±4.0 mmHg in breakthrough group and -14.0±5.0/ -9.8±4.7 mmHg in non-breakthrough group. Both SBP reduction and DBP reduction were significantly larger in breakthrough group than in non-breakthrough group(p<0.05). After additional administration of eplerenone, both baPWV(-11.0% vs-7.4%)and LVMI(-11.0% vs-10.6%)reduced significantly in the two groups(p<0.05, p<0.05). There was no significant difference in baPWV and LVMI reduction between the two groups. Conclusion:Eplerenone reduced blood pressure and protected the organs regardless of aldosterone breakthrough. The beneficial effect of administration of eplerenone seemed to be more remarkable in breakthrough group. These results suggested importance of additional administration of eplerenone to the hypertension patients who experienced elevation of plasma aldosterone concentration during administration of renin-angiotensin system inhibitors.
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