publication . Article . 2015

Safety and efficacy of eplerenone in patients at high risk for hyperkalemia and/or worsening renal function: Analyses of the EMPHASIS-HF study subgroups (eplerenone in mild patients hospitalization and survival study in heart failure)

Romain Eschalier; John J.V. McMurray; Karl Swedberg; D.J. Veldhuisen van; Henry Krum; Stuart J. Pocock; Harry Shi; John Vincent; Patrick Rossignol; F. Zannad; ...
Open Access English
  • Published: 01 Sep 2015
  • Publisher: Elsevier Inc.
Abstract
ObjectivesThe study sought to investigate the safety and efficacy of eplerenone in patients at high risk for hyperkalemia or worsening renal function (WRF) in EMPHASIS-HF, a trial that enrolled patients at least 55 years old with heart failure and reduced ejection fraction (HF-REF), in New York Heart Association (NYHA) functional class II and with an estimated glomerular filtration rate (eGFR) >30 ml/min/1.73 m2 and serum potassium 5.5, >6.0, and 5.5 mmol/l but not of potassium >6.0 mmol/l, and of hospitalization for hyperkalemia or discontinuation of study medication due to adverse events. Eplerenone was effective in reducing the primary composite endpoint in a...
Subjects
free text keywords: chronic kidney disease, diabetes, efficacy, elderly, eplerenone, safety, CHRONIC KIDNEY-DISEASE, MEDICAL THERAPY, ALDOSTERONE, SPIRONOLACTONE, PROTEINURIA, DYSFUNCTION, ANTAGONISTS, TRIAL, AGE, хроническая болезнь почек, сахарный диабет, эффективность, пожилые пациенты, эплеренон, безопасность, Therapeutics. Pharmacology, RM1-950, Diseases of the circulatory (Cardiovascular) system, RC666-701, lcsh:Therapeutics. Pharmacology, lcsh:RM1-950, lcsh:Diseases of the circulatory (Cardiovascular) system, lcsh:RC666-701, Internal medicine, medicine.medical_specialty, medicine, Heart failure, medicine.disease, In patient, Renal function, Hyperkalemia, medicine.symptom, Eplerenone, medicine.drug, Survival study, business.industry, business, Cardiology
22 references, page 1 of 2

1. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999;341:709-17.

2. Zannad F, McMurray JJV, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 2011;364: 11-21.

3. Pitt B, Remme W, Zannad F, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003;348:1309-21. [OpenAIRE]

4. McMurray JJV, Adamopoulos S, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2012;14:803-69.

5. Albert NM, Yancy CW, Liang L, et al. Use of aldosterone antagonists in heart failure. JAMA 2009;302:1658-65.

6. Zannad F, McMurray JJV, Drexler H, et al. Rationale and design of the Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure (EMPHASIS-HF). Eur J Heart Fail 2010;12:617-22.

7. Weidmann P, De Myttenaere-Bursztein S, Maxwell MH, De Lima J. Effect on aging on plasma renin and aldosterone in normal man. Kidney Int 1975;8:325-33.

8. Henschkowski J, Stuck AE, Frey BM, et al. Age-dependent decrease in 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2) activity in hypertensive patients. Am J Hypertens 2008;21:644-9.

9. Krug AW, Allenhöfer L, Monticone R, et al. Elevated mineralocorticoid receptor activity in aged rat vascular smooth muscle cells promotes a proinflammatory phenotype via extracellular signal-regulated kinase 1/2 mitogen-activated protein kinase and epidermal growth factor receptor-dependent pathways. Hypertension 2010;55:1476-83.

10. Johnson ES, Weinstein JR, Thorp ML, et al. Predicting the risk of hyperkalemia in patients with chronic kidney disease starting lisinopril. Pharmacoepidemiol Drug Saf 2010;19:266-72.

11. Preiss D, Van Veldhuisen DJ, Sattar N, et al. Eplerenone and newonset diabetes in patients with mild heart failure: results from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF). Eur J Heart Fail 2012;14:909-15.

12. Ma TK-W, Szeto C-C. Mineralocorticoid receptor antagonist for renal protection. Ren Fail 2012;34:810-7.

13. Funder JW. Aldosterone and mineralocorticoid receptors: orphan questions. Kidney Int 2000;57:1358-63.

14. Bianchi S, Bigazzi R, Campese VM. Long-term effects of spironolactone on proteinuria and kidney function in patients with chronic kidney disease. Kidney Int 2006;70:2116-23. [OpenAIRE]

15. Bomback AS, Kshirsagar AV, Amamoo MA, Klemmer PJ. Change in proteinuria after adding aldosterone blockers to ACE inhibitors or angiotensin receptor blockers in CKD: a systematic review. Am J Kidney Dis 2008;51:199-211. [OpenAIRE]

22 references, page 1 of 2
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