Is eplerenone an effective anti-hypertensive drug in overweight patients?

This study investigated if eplerenone (Inspra) reduces blood pressure (BP) in overweight or obese patients. They found that this treatment was effective at lowering BP, especially in elderly patients.

Hypertension or high blood pressure (BP) is a serious medical condition. High BP can be managed using a number of strategies. Lifestyle modifications and medication can lower BP. These drugs are called anti-hypertensives (AHTs). There are guidelines on when and what type of AHT to use. The standard of care recommends a treatment with one of 3 drug types. An ACE (angiotensin-converting enzyme) inhibitor or an angiotensin-receptor blocker (ARB) is the first option. Patients may also be treated with a thiazide diuretic (TD; water pill).

TD can also affect glucose metabolism. This can have a negative effect on patients with insulin resistance (IR). Many obese patients with hypertension also have IR. IR is one of the first steps towards diabetes. Aldosterone (Ald) is a hormone that partly regulates BP. High Ald is linked to IR. Eplerenone (EPN) is a drug that blocks Ald. It is unclear if EPN is more effective than TDs in overweight or obese patients. 

This study included 165 patients with hypertension. Patients were randomly assigned to EPN (50- 100 mg/day) or TD treatment. The TD was trichlormethiazide (TCMZ, 1-2 mg/day)). Patients were assessed after 6 months of treatment. Body mass index (BMI) was used to classify weight status. Systolic and diastolic BP (SBP, DBP) and glucose metabolism were the main outcomes of interest. 

SBP and DBP were significantly lower in both groups at 6 months. When the results were adjusted for age, sex, and BMI, EPN was more effective at reducing BP. EPN was more effective than TCMZ in patients over 65.  There was no significant difference in glucose metabolism between the two groups.

The authors concluded that EPN was effective at lowering BP, especially in elderly patients.

This was a relatively small study. BP was measured at office visits and 24-hour BP readings could differ. More investigation is needed.

If you have any concerns regarding hypertension, please discuss with your doctor.