Eplerenone for hypertension

摘要: Background Eplerenone is an aldosterone receptor blocker that chemically derived from spironolactone. In Canada, it indicated for use as adjunctive therapy to reduce mortality heart failure patients with New York Heart Association (NYHA) class II systolic chronic and left ventricular dysfunction. It also used following myocardial infarction. Additionally, the treatment of mild moderate essential hypertension who cannot be treated adequately other agents. important determine clinical impact all antihypertensive medications, including antagonists, support their continued in hypertension. No previous systematic reviews have evaluated effect eplerenone on cardiovascular morbidity, mortality, magnitude blood pressure lowering hypertension. Objectives To assess effects monotherapy versus placebo primary adults. Outcomes interest were all-cause events (fatal or non-fatal infarction), cerebrovascular non fatal strokes), adverse withdrawals due events, diastolic pressure. Search methods We searched Cochrane Hypertension Specialised Register, CENTRAL, MEDLINE, Embase, two trials registers up 3 March 2016. We handsearched references retrieved studies identify any missed initial search. unpublished data by contacting corresponding authors included pharmaceutical companies involved conducting The search had no language restrictions. Selection criteria We selected randomized placebo-controlled studying adult excluded people secondary gestational where participants receiving multiple antihypertensives. Data collection analysis Three review independently reviewed results meeting our criteria. Three extracted assessed trial quality using a standardized extraction form. A fourth independent author resolved discrepancies disagreements. performed synthesis format Covidence. conducted analysis Review Manager 5. Main results A total 1437 participated five parallel group studies, durations ranging 8 16 weeks. daily doses ranged 25 mg 400 daily. Meta-analysis these showed reduction 9.21 mmHg (95% CI −11.08 −7.34; I2 = 58%) 4.18 −5.03 −3.33; 0%) (moderate evidence). There may dose response at mg/day. However, this finding uncertain, based single study low evidence. Overall there does not appear clinically 50 There did differences number withdrew least one event compared placebo. only three reported events. Most quality, we judged domains being unclear risk 'Risk bias' assessment. Authors' conclusions Eplerenone 200 mg/day lowers placebo, difference between produce statistically significant insufficient evidence above currently available meaningful outcomes such morbidity hypertensive patients. side which makes impossible draw conclusions about potential harm associated