Effect of eplerenone on parathyroid hormone levels in patients with primary hyperparathyroidism

• Verfasst von: Tomaschitz, Andreas [VerfasserIn]
• Verfasst von: März, Winfried [VerfasserIn]
• Verfasst von: Ritz, Eberhard [VerfasserIn]
• Titel: Effect of eplerenone on parathyroid hormone levels in patients with primary hyperparathyroidism
• Titelzusatz: results from the Epath randomized, placebo-controlled trial
• Verf.angabe: Andreas Tomaschitz, Nicolas Verheyen, Andreas Meinitzer, Burkert Pieske, Evgeny Belyavskiy, Helmut Brussee, Josef Haas, Winfried März, Elisabeth Pieske-Kraigher, Sarah Verheyen, Lisa Ofner-Ziegenfuss, Bríain Ó Hartaigh, Verena Schwetz, Felix Aberer, Martin Grübler, Florian Lang, Ioana Alesutan, Jakob Voelkl, Martin Gaksch, Jörg H. Horina, Hans-Peter Dimai, Jutta Rus-Machan, Claudia Stiegler, Eberhard Ritz, Astrid Fahrleitner-Pammer, and Stefan Pilz
• E-Jahr: 2016
• Jahr: 11 March 2016
• Umfang: 10 S.
• Fussnoten: Gesehen am 14.02.2018
• Titel Quelle: Enthalten in: Journal of hypertension
• Ort Quelle: London : Lippincott, Williams & Wilkins, 1983
• Jahr Quelle: 2016
• Band/Heft Quelle: 34(2016), 7, Seite 1347-1356
• ISSN Quelle: 1473-5598
• DOI: doi:10.1097/HJH.0000000000000927
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1569844550

Abstract

Accumulating evidence points toward mutual interaction between parathyroid hormone (PTH) and aldosterone as potential mechanism for increasing cardiovascular risk in primary hyperparathyroidism (pHPT). The Eplerenone on parathyroid hormone levels in patients with primary hyperparathyroidism (EPATH) trial is a single-center, randomized, double-blind, parallel-group, placebo-controlled trial. The primary aim is to evaluate the effects of the mineralocorticoid receptor antagonist eplerenone on plasma intact PTH (iPTH) concentration in patients with pHPT. Secondary end points comprised surrogate parameters of cardiovascular health [24-h ambulatory SBP and DBP and echocardiographic parameters related to systolic/diastolic function as well as to cardiac dimensions]. We enrolled 110 study participants with pHPT, 25-hydroxyvitamin D at least 20 ng/ml and estimated glomerular filtration rate more than 50 ml/min per 1.73 m2. Patients were 1 : 1 randomly assigned to receive either 25 mg eplerenone once daily (up-titration after 4 weeks to 50 mg/day) or matching placebo for a treatment period of 8 weeks. The study was completed by 97 participants [mean (SD) age: 67.5 ± 9.5 years; 78.4% women). The mean treatment effect (95% confidence interval) for iPTH was 1.0 (0.9-1.1; P = 0.777) pg/ml. Mean 24-h ambulatory SBP and DBP decreased significantly [mean change (95% confidence interval) −6.3 (−9.4 to −3.3) and −3.7 (−5.7 to −1.7) mmHg, respectively; P < 0.001]. No differences were seen in any further secondary outcomes or frequency of adverse events. In pHPT, treatment with eplerenone compared with placebo had no effect on circulating iPTH levels. Eplerenone treatment was well tolerated and safe and followed by significant decrease of ambulatory blood pressure.