The promise of selective aldosterone receptor antagonists for the treatment of hypertension and congestive heart failure

被引:10
作者
Hameedi A. [1 ]
Chadow H.L. [1 ]
机构
[1] Division of Cardiology, Brookdale University Hospital, Medical Center, Brooklyn, NY 11212-3198
关键词
Aldosterone; Angiotensin Converting Enzyme; Angiotensin Converting Enzyme Inhibitor; Spironolactone; Eplerenone;
D O I
10.1007/s11906-000-0041-z
中图分类号
学科分类号
摘要
Inappropriate elevations in plasma aldosterone levels have multiple actions that play an important role in the pathophysiology of hypertension and heart failure. Patients with hypertensive cardiovascular disease are at increased risk for coronary artery disease, myocardial infarction, congestive heart failure, and sudden cardiac death. Despite long-term treatment with an angiotensin converting enzyme inhibitor or an angiotensin II receptor blocker, aldosterone levels usually remain high in these patients. The effectiveness of low-dose spironolactone raises the possibility that a nonselective aldosterone antagonist can block the deleterious effects of aldosterone on the cardiovascular system. However, side effects limit the use of this drug in many patients. The advent of selective aldosterone antagonists, which have a lower affinity for androgen and progesterone receptors, should minimize these side effects, leading to better compliance. Copyright © 2000 by Current Science Inc.
引用
收藏
页码:378 / 383
页数:5
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  • [1] The sixth report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure, Arch Intern Med, 157, pp. 2413-2446, (1997)
  • [2] Burt V.L., Cutler J.A., Higgins M., Et al., Trends in the prevalence, awareness, treatment, and control of hypertension in the US adult population. Results from the third national health and nutrition examination survey, 1988-1991, Hypertension, 25, pp. 305-313, (1995)
  • [3] Samuelsson O., Hedner T., Berglund G., Diabetes mellitus in treated hypertension: Incidence, predictive factors and the impact of non selective beta blockers and thiazide diuretics during 15 years of treatment of middle age hypertensive men in the primary prevention trial Goteborg, Sweden, J Hum Hypertens, 8, pp. 257-263, (1994)
  • [4] Gress T.W., Nieto F.J., Shahar E., Et al., Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. Atherosclerosis Risk in Communities Study, N Engl J Med, 342, pp. 905-912, (2000)
  • [5] Siscovick D.S., Raghunathan T.E., Psaty B.M., Et al., Diuretic therapy for hypertension and the risk of primary cardiac arrest, N Engl J Med, 330, pp. 1852-1857, (1994)
  • [6] Garg R., Gorlin R., The effect of digoxin on mortality and morbidity in patients with heart failure. The Digitalis Investigation Group, N Engl J Med, 336, pp. 525-532, (1997)
  • [7] Howard C.A., Daniel D.L., Davis C.E., Et al., Diuretics and risk of arrhythmic death in patients with left ventricular dysfunction, Circulation, 100, pp. 1311-1315, (1999)
  • [8] Pitt B., Zannad F., Remme W.J., Et al., The effects of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized aldactone evaluation study investigators, N Engl J Med, 341, pp. 709-717, (1999)
  • [9] Williams G.H., Aldosterone: New concepts in mechanism of action, J Hypertens
  • [10] Gottlieb S.S., Baruch L., Kuklin M.L., Prognostic importance of the serum magnesium concentration in patients with congestive heart failure, J Am Coll Cardiol, 16, pp. 827-831, (1990)