Comparative dose-response and safety of eplerenone, enalapril, losartan, and amlodipine in patients with essential hypertension

Comparative efficacy data are useful in evaluating the utility of new therapeutic agents. Data from 3 titration-to-effect antihypertensive trials comparing eplerenone (EPL) with enalapril (ENAL), losartan (LOS), and amlodipine (AML), respectively, of 16 to 24 weeks in duration were summarized to evaluate efficacy and safety data from a setting that closely mimics clinical practice. Each study provided guidelines for dose escalation if BP remained uncontrolled: EPL 50–200 mg, ENAL 10–40 mg, LOS 50–100 mg, and AML 2.5–10 mg. BP reduction and safety at each dose level were evaluated. Results demonstrated comparable efficacy between EPL and the comparator agents at the initial and second dose levels: (See Table) WHT = white patients, BLK = black patients. Event profiles were comparable between EPL and the comparative agents at each dosage level. Incidence of diarrhea was greater for ENAL 10 mg versus EPL 50 mg (P=0.029). There were no differences between EPL versus LOS, or EPL versus AML for any single event at a given dose. In conclusion, the efficacy and safety of EPL compared favorably to that of widely used antihypertensive agents. BP reductions were similar to agents compared to EPL monotherapy in these studies.