Comparison of Eplerenone and Spironolactone in Treatment of Patients with Congestive Heart Failure Visiting a Tertiary Hospital in North India
Abstract
Background: Congestive heart failure (CHF) is a serious clinical condition, with not many established treatment options. Eplerenone (Inspra) is the second aldosterone antagonist commonly used (in preference to Spironolactone) for treatment of hypertension and CHF in the US. Literature for its effectiveness in India is lacking, hence the need for the present study.
Methodology: The present cross-sectional, observational study was done among 100 adult patients (>20 years) (50 patients in each study group: Eplerenone and Spironolactone), diagnosed with chronic CHF and poor left ventricle function (ejection fraction <40%) unknown of their blood pressure status. Sociodemographic profile, clinical and laboratory status was evaluated which included blood pressure measurements, lipid profile, kidney function tests, and other vitals. Assessment of parameters was done after 8 weeks of treatment.
Results: Systolic blood pressure, diastolic blood pressure and CK levels showed a significant change over the study duration, with Eplerenone producing a better result than Spironolactone (p<0.05). Remaining parameters showed a non-significant difference.
Conclusion: Eplerenone group proved to be associated with a better outcome in hypertension and cardiovascular parameters; however, due to limitations in sample selection, more research is warranted.
Keywords
Full Text:
PDFReferences
Congestive Heart Failure. [Internet]. Available on:
http://www.mercksource.com/pp/us/cns/cns_hl_
dorlands_split.jsp ?pg=/ppdo cs/us/common/dorlands/
dorland/four/000047501.htm.
Hobbs R, Boyle A. Heart Failure. [Internet]. Available
on: www.clevelandclinicmed.com/medicalpubs/
diseasemanagement/cardiology/heart-failure.
Definition of Heart Failure. [Internet]. Available
on: http://www.mayoclinic.com/health/heartfailureIDS00061.
Asscia C. Facts about congestive heart failure. [Internet].
Available on: www.cardioassoc.com/patientygs/
conditions/congestive.asp.
Kleiman J, Krause S, Burns D et al. Effects of Eplerenone,
Enalapril, and Eplerenone/Enalapril in patients with
essential hypertension and left ventricular hypertrophy:
the 4E-left ventricular hypertrophy study. Circulation
; 108: 1831-38.
Satoskar RS et al. Pharmacology and Pharmacotherapeutics.
Revised 23rd edition. Chap 38: 567-68.
Ray S, Gupta R. Strategies for chronic heart failure
management. Association of Physicians of India Chap
: 164-65.
Shaikh Z, Pathak R. Revised Kuppuswamy and BG Prasad
socio-economic scales for 2016. Int J Community Med
Public Health 2017; 4: 997-99.
Craft J. Eplerenone (Inspra), a new aldosterone
antagonist for the treatment of systemic hypertension
and heart failure. Proceedings Baylor University Medical
Center 2004; 17(2): 217-20.
Inspra, Eplerenone [product information] Pfizer
Pharmaceuticals Jun 2003.
White WB, Carr AA, Krause S et al. Assessment of the
novel selective aldosterone blocker Eplerenone using
ambulatory and clinical blood pressure in patients with
systemic hypertension. Am J Cardiol 2003; 92: 38-42.
Flack JM, Oparil S, Pratt JH et al. Efficacy and tolerability
of Eplerenone and losartan in hypertensive black and
white patients. J Am Coll Cardiol 2003; 41: 1148-55.
Pitt B, Zannad F. Eplerenone: Is it time to add this drug
to current heart failure therapy? Therapeutic Advances
in Chronic Disease 2012; 3(1): 5-9.
Marcy TD, Ripley TR. Aldosterone antagonists in the
treatment of heart failure. Am J Health Syst Pharm
; 63(1): 49-58.
Pitt B, Zannad F, Remme WJ et al. The effect of
Spironolactone on morbidity and mortality in patients
with severe heart failure. N Engl J Med 1999; 341:
-17.
Pitt B, Reichek N, Willenbrock R, et al. Effects of
Eplerenone, Enalapril, and Eplerenone/Enalapril in
patients with essential hypertension and left ventricular
hypertrophy: the 4E-left ventricular hypertrophy study.
Circulation 2003; 108: 1831-38.
Goodfriend TL, Egan B, Stepniakowski K et al.
Relationships among plasma aldosterone, highdensity
lipoprotein cholesterol, and insulin in humans.
Hypertension 1995; 25: 30-36.
Guo C, Ricchiuti V, Lian BQ et al. Mineralocorticoid
receptor blockade reverses obesity-related changes
in expression of adiponectin, peroxisome proliferatoractivated
receptor-gamma, and pro-inflammatory
adipokines. Circulation 2008; 117: 2253-61.
Wada T, Kenmochi H, Miyashita Y et al. Spironolactone
improves glucose and lipid metabolism by ameliorating
hepatic steatosis and inflammation and suppressing
enhanced gluconeogenesis induced by high-fat and
high-fructose diet. Endocrinology 2010; 151: 2040-49.
Mephisto Study Group. Effectiveness of Eplerenone
or Spironolactone treatment in preserving renal
function in primary aldosteronism. European Journal
of Endocrinology 2013; 168: 75-81.
Refbacks
- There are currently no refbacks.
Copyright (c) 2018 Journal of Advanced Research in Medicine (P-ISSN:2394-7047 & E-ISSN:2349-7181)

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.