The effectiveness of eplerenone in clinical practice from the standpoint of evidence-based medicine (twenty years on the guard of life)

The article focuses on the negative role of hyperaldosteronism in cardiovascular diseases and the possibility of its control when using a selective mineralocorticoid receptor antagonist – eplerenone. Based on numerous, multicenter clinical studies, the advantage of using eplerenone in the complex therapy of cardiovascular diseases has been shown. Eplerenone is a selective mineralocorticoid receptor blocker with minimal activity against androgen and progesterone receptors. From the modern point of view, eplerenone is considered as an antifibrotic drug with a dual mechanism of action: the drug blocks the K⁺-channels of regulatory T-lymphocytes, reduces the production of growth cells and helps to reduce the proliferation of cardiac fibroblasts; blockade of mineralocorticoid receptors by aldosterone leads to a decrease in the activation of fibroblasts. The antifibrotic effect contributes to the preservation of contractility and electrical stability of the myocardium, slows down the development and progression of chronic heart failure. The article presents data, in the framework of evidence-based medicine, on the high clinical efficacy of eplerenone in patients with arterial hypertension, chronic heart failure with reduced ejection fraction with or without myocardial infarction. The possibilities of prescribing eplerenone for moderately reduced and preserved left ventricular ejection fraction are discussed. The importance of the antifibrotic properties of the drug in the organoprotection of target organs (heart, blood vessels, kidneys) is emphasized. The use of eplerenone provides good tolerability, safety and leads not only to an improvement in the quality of life of severely ill patients, but also in the prognosis. The tactics of choosing a specific eplerenone drug for comorbid patients with chronic heart failure and chronic kidney disease with a glomerular filtration rate of 30 to 60 ml/min, based on instructions for use and availability for the patient, are also considered.

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