Effects of eplerenone on blood pressure and glucose metabolism in Japanese hypertensives with overweight or obesity

Objective: The impact of aldosterone blockade using eplerenone on hypertensives with obesity has not been clarified. We compared the efficacy and safety between eplerenone and trichlormethiazide in hypertensives with overweight or obesity. Methods: A prospective, randomized, open-labeled, blinded-endpoint design, multicenter trial enrolled 204 hypertension-treated outpatients with obesity [body mass index (BMI) >= 25kg/m(2)] evaluated by ambulatory blood pressure (BP) measurement. Patients were randomly assigned to receive 50mg of eplerenone (n=102) or 1mg of trichlormethiazide (n= 102), each of which were administered once every morning. Primary efficacy endpoints were systolic and diastolic BPs and biomarkers of glucose metabolism after 6 months of treatment. Results: At baseline, BPs were comparable between the two groups. Systolic/diastolic blood pressure (SBP/DBP) were reduced from 153.9 +/- 12.6/84.6 +/- 11.8 to 129.8 +/- 14.2/73.7 +/- 12.2 mm Hg by eplerenone therapy and from 152.2 +/- 12.5/85.2 +/- 10.9 to 133.8 +/- 12.6/76.1 +/- 8.6 mm Hg by trichlormethiazide therapy (all; P <.001). The efficacy of SBP reduction after adjustment for age, sex, and BMI was significantly greater in the eplerenone group than the trichlormethiazide (P=. 034), although the efficacy of DBP reduction was marginally significant (P=. 072). Especially, the efficacy of BP reduction was more effective for aged over 65 years than less than 65 years. However, biomarkers of glucose metabolism were not significantly different between these 2 groups. Conclusion: The eplerenone therapy was more effective in BP lowering in hypertensives with overweight or obesity than the trichlormethiazide therapy, especially in the elderly.