ASH SPECIAL ISSUE REVIEW PAPER
Aldosterone Blockers (Mineralocorticoid Receptor Antagonism) and Potassium-Sparing Diuretics
Article first published online: 9 AUG 2011
© 2011 Wiley Periodicals, Inc.
The Journal of Clinical Hypertension
Volume 13, Issue 9, pages 644–648, September 2011
How to Cite
Epstein, M. and Calhoun, D. A. (2011), Aldosterone Blockers (Mineralocorticoid Receptor Antagonism) and Potassium-Sparing Diuretics. The Journal of Clinical Hypertension, 13: 644–648. doi: 10.1111/j.1751-7176.2011.00511.x
- Issue published online: 6 SEP 2011
- Article first published online: 9 AUG 2011
J Clin Hypertens (Greenwich). 2011;13:644–648. ©2011 Wiley Periodicals, Inc.
Key Points and Practical Recommendations
- •Mineralocorticoid receptor (MR) antagonists (aldosterone blockers) provide effective antihypertensive treatment, especially in low-renin and salt-sensitive forms of hypertension, including resistant hypertension.
- •Newer, more selective MR antagonists (eg, eplerenone) have fewer of the progestational and antiandrogenic effects than spironolactone, enhancing tolerability and potentially improving adherence to therapy.
- •MR antagonists provide an additional benefit in the treatment of heart failure when combined with angiotensin-converting enzyme inhibitors, digoxin, and loop diuretics.
- •Other potassium-sparing diuretics (amiloride or triamterene) are generally prescribed for essential hypertension as a fixed-dose combination with hydrochlorothiazide.
- •The dose range for spironolactone with resistant hypertension is between 25 mg/d and 50 mg/d, and eplerenone is an appropriate alternative if spironolactone is not tolerated because of sexual side effects.
- •In general, the combined use of spironolactone and adequate doses of a thiazide diuretic or a thiazide-like agent such as chlorthalidone for the treatment of resistant hypertension maximizes efficacy and reduces the risk of spironolactone-induced hyperkalemia.