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Background <p>Resistant hypertension affects 10–15% of treated patients and remains a therapeutic challenge. Eplerenone is recommended when spironolactone is ineffective or poorly tolerated. Central blood pressure (BP) correlates more strongly with cardiovascular complications than peripheral BP, and pulse wave velocity (PWV) reflects arterial stiffness, a key factor in hypertension-related morbidity. While spironolactone is well-established for resistant hypertension, data on eplerenone’s efficacy and safety for this indication is limited. Interleukin-6 (IL-6) is involved in resistant hypertension and the pressor response to angiotensin II, with elevated levels suggesting its role in aldosterone regulation and potential as a therapeutic target. This study aimed to evaluate the efficacy of eplerenone (25–50&#xa0;mg/day) on central aortic BP, PWV, office BP, ambulatory BP monitoring (ABPM), and IL-6 levels after four weeks. Twenty-seven patients with confirmed resistant hypertension received eplerenone for four weeks. Office BP, ABPM, central aortic BP, PWV, and safety markers (potassium, creatinine) were measured. IL-6 levels were assessed at baseline and post-treatment.</p> Results <p>Significant reductions were observed in office BP (SBP: −13.93 mmHg, DBP: −7.64 mmHg), aortic BP (SBP: −13.42 mmHg, DBP: −7.94 mmHg), 24&#xa0;h-ABPM (SBP: −7 mmHg, DBP: −3 mmHg), and PWV (− 1.52&#xa0;m/s). Doubling the eplerenone dose from 25&#xa0;mg to 50&#xa0;mg daily reduces aortic systolic blood pressure threefold. IL-6 levels also decreased significantly (<i>p</i> = 0.023).</p> Conclusions <p>Eplerenone effectively reduces central and peripheral BP, arterial stiffness, and IL-6 levels, potentially lowering cardiovascular risk in resistant hypertension.</p>

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Efficacy of 4 Weeks Therapy with Eplerenone in Resistant Hypertension: Reduction of Aortic Blood Pressure, Arterial Stiffness, and Impact on IL-6 Levels

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月28日

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  • Stanisław Wasiliew,
  • Dawid Lipski,
  • Łukasz Stryczyński,
  • Artur Radziemski,
  • Jan Królak,
  • Andrzej Tykarski,
  • Paweł Uruski

摘要

Background

Resistant hypertension affects 10–15% of treated patients and remains a therapeutic challenge. Eplerenone is recommended when spironolactone is ineffective or poorly tolerated. Central blood pressure (BP) correlates more strongly with cardiovascular complications than peripheral BP, and pulse wave velocity (PWV) reflects arterial stiffness, a key factor in hypertension-related morbidity. While spironolactone is well-established for resistant hypertension, data on eplerenone’s efficacy and safety for this indication is limited. Interleukin-6 (IL-6) is involved in resistant hypertension and the pressor response to angiotensin II, with elevated levels suggesting its role in aldosterone regulation and potential as a therapeutic target. This study aimed to evaluate the efficacy of eplerenone (25–50 mg/day) on central aortic BP, PWV, office BP, ambulatory BP monitoring (ABPM), and IL-6 levels after four weeks. Twenty-seven patients with confirmed resistant hypertension received eplerenone for four weeks. Office BP, ABPM, central aortic BP, PWV, and safety markers (potassium, creatinine) were measured. IL-6 levels were assessed at baseline and post-treatment.

Results

Significant reductions were observed in office BP (SBP: −13.93 mmHg, DBP: −7.64 mmHg), aortic BP (SBP: −13.42 mmHg, DBP: −7.94 mmHg), 24 h-ABPM (SBP: −7 mmHg, DBP: −3 mmHg), and PWV (− 1.52 m/s). Doubling the eplerenone dose from 25 mg to 50 mg daily reduces aortic systolic blood pressure threefold. IL-6 levels also decreased significantly (p = 0.023).

Conclusions

Eplerenone effectively reduces central and peripheral BP, arterial stiffness, and IL-6 levels, potentially lowering cardiovascular risk in resistant hypertension.