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依普利酮治疗高血压疗效好吗？
(Inspra) selectively acts on aldosterone receptors, is highly selective for mineralocorticoid receptors, and has less effect on androgen and progesterone receptors. Its affinity for mineralocorticoids is 15 to 20 times that of spironolactone, while its affinity for androgen and progesterone receptors is 500 times smaller than that of spironolactone, so sex hormone-related adverse reactions are less likely to occur. Currently it is mainly used to treat hypertension and left ventricular dysfunction after acute myocardial infarction. It can effectively lower blood pressure, improve cardiac function and reduce myocardial damage.
The effect of eplerenone in treating high blood pressure:
Subgroup analysis of the EPHESUS study showed that the effect of eplerenone on reducing overall mortality was more obvious in patients with hypertension. A comparative study on the efficacy and tolerability of 499 patients with grade 1 or 2 hypertension who were randomized to receive enalapril or eplerenone showed that at 6 months, enalapril was as effective as eplerenone in reducing systolic blood pressure (eplerenone decreased by 14.5 mmHg; enalapril decreased by 12.7 mmHg; P=0.199) and diastolic blood pressure (eplerenone decreased by 11.2 mmHg; enalapril decreased by 11.3 mm). Hg; P=0.910). After 12 months, the two groups were also similar (eplerenone -16.5/-13.3mmHg; enalapril -14.8/-14.1mmHg, P values 0.251 and 0.331 respectively).
Dropout due to adverse events (7.9% for eplerenone and 9.3% for enalapril at 6 months) and treatment failure rates were also equal (23.3% for eplerenone and 22.8% for enalapril at 6 months).
About 2/3 of the patients in each group achieved normal blood pressure at 6 months with the above single treatment. In the group, the decrease in blood pressure was independent of renin levels, unlike enalapril. Both groups could reduce proteinuria above normal levels, but the eplerenone (Inspra) group was more significant (-61.5% vs -25.7%; P=0.01).
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