Aldosterone blockers (mineralocorticoid receptor antagonism) and potassium-sparing diuretics

Abstract

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 25mg/d and 50mg/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. © 2011 Wiley Periodicals, Inc.