依普利酮效果如何？

(eplerenone) is the first selective aldosterone receptor antagonist. It has been 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.

In the treatment of heart failure: The EPHESUS trial showed that for patients with left ventricular ejection fraction (LVEF) <40% and heart failure within 3 to 14 days after myocardial infarction, the addition of eplerenone to standard treatment can reduce all-cause death by 15%, primary combined endpoint events (cardiovascular death or hospitalization for cardiovascular events) by 17%, and sudden cardiac death by 21% ( sudden cardiac death (SCD). For patients with a history of hypertension after acute myocardial infarction, heart failure, and LVEF ≤ 40%, the addition of eplerenone can significantly reduce all-cause mortality, primary combined endpoints, and SCD. For patients without a history of hypertension, although eplerenone can reduce heart failure hospitalization, it does not reduce mortality and other endpoints. Hospitalization due to hypertension is a risk factor for cardiovascular death, and eplerenone can reduce the risk of hospitalization due to hypertension in people without a history of hypertension. Because the use of eplerenone early (3-7 days) after acute myocardial infarction can reduce primary combined endpoint events by 24% and SCD by 34%. However, if eplerenone is used for ≥ 7 days, the effect of improving the prognosis is not obvious.

In the treatment of hypertension: in the treatment of patients with stage 1 and stage 2 hypertension, the effectiveness and magnitude of reducing systolic blood pressure and diastolic blood pressure are similar to those of enalapril. Eplerenone also has a good antihypertensive effect in patients with essential hypertension with low renin levels for whom angiotensin-converting enzyme inhibitors and angiotensin II receptor inhibitors are not effective. It also has a good antihypertensive effect on simple systolic hypertension, and has a good antihypertensive effect on diet-induced obesity-related hypertension. In addition, eplerenone can significantly reduce the ultrafiltration effect of glomeruli and reduce albuminuria in patients with hypertension. This renal protective effect is more obvious for hypertensive patients with diabetes.