In the EPHESUS study reported by Pitt et al., eplerenone, a selective aldosterone blocker, administered to patients with left ventricular dysfunction after myocardial infarc¬tion proved beneficial. In the study 3313 patients were randomly assigned eplerenone, 25 mg daily to a maximum of 50 mg or placebo and 3319 patients were administered optimal medical therapy.
Results: During a mean follow up of 16 months, there were 478 deaths in the eplerenone group and 554 deaths in the placebo group (P ¼ 0.008). There were 407 cardiovas¬cular deaths in the eplerenone group and 483 in the placebo group (P ¼ 0.005). The rate of death from cardiovascular causes or hospitalization for cardiovascular events was reduced by eplerenone (P ¼ 0.002), as was death from any cause or any hospitalization (P ¼ 0.02). The rate of sudden cardiac death was significantly reduced (P ¼ 0.03). The rate of serious hyperkalemia was 5.5% in the eplerenone group and 3.9% in the placebo group (P ¼ 0.002). The rate of hypokalemia was 8.4% in the eplerenone group and 13.1% in the placebo group (P < 0.001).
Eplerenone possesses the beneficial actions of spirono-lactone without the drawback of gynecomastia. This drug is not advisable in patients with a serum creatinine of >1.1 mg/dl because hyperkalemia may be precipitated.