How does eplerenone work?
Jász-Nagykun-Szolnok Megyei Hetényi Géza Kórház-Rendelőintézet, Kardiológiai Osztály Szolnok
It is a key issue to understand in common clinical practice why it is important to block the activated renin-angiotensin-aldosterone system at two different points of action. The author analyzes in detail the escape mechanisms, and on the other hand, the interdependence within the renin-angiotensin-aldosterone system and amongst the components of the whole neuroendocrine activation, that justifies the approach mentioned above. A significant part of this analysis is to describe the advantages of using eplerenone over its „precursor”, spironolactone, and how these advantages hold for the extension of treatment with mineralocorticoid receptor antagonists. The major problems going forward are to determine the mechanism of the remodeling effect of eplerenone, the components involved, and the time course of this process. Knowing the dynamics of remodeling, we should, by being able to optimize the time of initiation of eplerenone therapy, to best utilize the potential of this therapy.