Hypertension and ethnic group: Eplerenone may have role in hypertension related atrial fibrillation

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7547.974-b (Published 20 April 2006) Cite this as: BMJ 2006;332:974
  1. Oscar M Jolobe, retired geriatrician (oscarjolobe{at}yahoo.co.uk)
  1. Didsbury M20 2RN

    EDITOR—Not with standing the fact that the preferred option for black people is the antihypertensive drug regimen comprising calcium channel blockers and diuretics,1 adjunctive treatment that reduces the risk of hypertension related atrial fibrillation also needs to be considered.

    On meta-analysis, angiotensin converting enzyme (ACE) inhibitors, as well as angiotensin receptor blockers, have this effect.2 The focus must now be on the blockade of those components of the renin-angiotensinaldosterone system that are “race neutral.” Promising results come from a study comprising at least 409 patients, including subgroups in whom 15-25% of the subjects were black. In that study, a blood pressure lowering effect attributable to the aldosterone blocker eplerenone was documented in white as well as black people.3

    In a smaller study, in which patient subgroups were characterised by a 4-6% content of black people, the adjunctive use of eplerenone enhanced the antihypertensive effect of ACE inhibitors and angiotensin receptor blockers.4 Even more encouraging is the prospective study of 168 subjects (including 55 black participants) with low renin hypertension in whom eplerenone proved to have better antihypertensive efficacy than losartan.5 These studies are sufficiently encouraging to prompt a prospective study to evaluate the role of aldosterone blockade in reducing the risk of hypertension related atrial fibrillation in low renin hypertension irrespective of race.

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    • Competing interests None declared.


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