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Rapid response to:

Practice

Hypertension and ethnic group

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7545.833 (Published 06 April 2006) Cite this as: BMJ 2006;332:833

Rapid Response:

a possible role for eplerenone in hypertension-related atrial fibrillation

Notwithstanding the fact that the preferred option for blacks is the
CD antihypertensive drug regime comprising calcium channel blockers and
diuretics, respectively(1), adjunctive treatment which reduces the risk of
hypertension-related atrial fibrillation(AF) also needs to be considered.

On meta analysis, angiotensin converting enzyme (ACE) inhibitors, as well
as angiotensin receptor blockers (ARBs), have this effect(2), validated,
in the latter instance, in a prospective study using losartan as the ARB
agent(3). The focus must now be on the blockade of those components of the
renin-angiotensin-aldosterone system which are "race neutral". Promising
results come from a study comprising at least 409 patients, including
subgroups in whom 15-25% of the subjects were blacks. In that study a
blood pressure lowering effect attributable to the aldosterone blocker
eplerenone was documented in whites as well as blacks(4).

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

References

(1) Brown M
Hypertension and ethnic group
BMJ 2006:332:833-6

(2) Madrid A., Peng J., Zamora J et al
The role of angiotensin receptor blockers and/or angiotensin converting
enzyme inhibitors in the prevention of atrial fibrillation in patients
with cardiovascular diseases
Pacing Clin Electrophysiol 2004:27:1405-10

(3) Watchell K., Lehto M., Gerdts E et al
Angiotensin II receptor blockade reduces new-onset atrial fibrillation and
subsequent stroke compared to atenolol
J Am Coll Cardiol 2005:45:712-9

(4) Weinbereger MH., Roniker B., Krause SL., Weiss RJ
Eplerenone, a selective aldosterone blocker, in mild to moderate
hypertension
Am J Hypertens 2002:15:709-16

(5) Krum H., Nolly H., Workman D et al
Efficacy of eplerenone added to renin-angiotensin blockade in hypertensive
patients
Hypertension 2002:40:117-23

(6) Weinbereger MH., White WB., Ruilope L-M et al
Effects of eplerenone versus losartan in patients with low-renin
hypertension
Am Heart J 2005:150:426-33

Competing interests:
None declared

Competing interests: No competing interests

11 April 2006
oscar,m jolobe
retired geriatrician
1 The Lodge, 842 Wilmslow Road, Didsbury m20 2RN