Clinical InvestigationAcute Ischemic Heart DiseaseEffects of eplerenone versus losartan in patients with low-renin hypertension
Section snippets
Study population
Patients with hypertension were recruited from 26 study sites in 4 countries (France, Spain, Scotland, and United States). Hypertensive patients 18 years or older with mean seated clinic diastolic blood pressures of ≥90 and <115 mm Hg and mean seated systolic blood pressures of <200 mm Hg were included if they had not received β blockers or clonidine for ≥2 weeks, and demonstrated at least 1 of the following: (1) 2 repeated values of morning plasma renin activity ≤1.0 ng/mL per hour, (2) an
Patient demographics and disposition
A total of 168 patients were randomized to treatment by 26 investigators in 4 countries. Of these, 86 were treated with eplerenone and 82 received losartan, which provided 88% power to detect a 3.5-mm Hg difference in seated diastolic blood pressure. The characteristics of the patient groups were similar at baseline (Table I).
Mean seated blood pressures at baseline were similar in the eplerenone and losartan groups (Table I). Baseline geometric mean active plasma renin values also were similar
Discussion
Inhibition of the RAAS has been a primary focus of therapy for patients with hypertension. It is well established that ACE inhibitors and angiotensin receptor blockers are particularly effective in patients with an activated RAAS. However, the response of different patients to the same antihypertensive drug is heterogeneous. In patients without apparent RAAS activation, blood pressures do not respond to inhibition of serum ACE activity as well as they do in patients with high or normal renin
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