Aldosterone blockers (mineralocorticoid receptor antagonism) and potassium-sparing diuretics

J Clin Hypertens (Greenwich). 2011 Sep;13(9):644-8. doi: 10.1111/j.1751-7176.2011.00511.x. Epub 2011 Aug 9.


KEY POINTS AND PRACTICAL RECOMMENDATIONS: • Mineralocorticoid receptor (MR) antagonists (aldosterone blockers) provide effective antihypertensive treatment, especially in low-renin and salt-sensitive forms of hypertension, including resistant hypertension. • Newer, more selective MR antagonists (eg, eplerenone) have fewer of the progestational and antiandrogenic effects than spironolactone, enhancing tolerability and potentially improving adherence to therapy. • MR antagonists provide an additional benefit in the treatment of heart failure when combined with angiotensin-converting enzyme inhibitors, digoxin, and loop diuretics. • Other potassium-sparing diuretics (amiloride or triamterene) are generally prescribed for essential hypertension as a fixed-dose combination with hydrochlorothiazide. • The dose range for spironolactone with resistant hypertension is between 25 mg/d and 50 mg/d, and eplerenone is an appropriate alternative if spironolactone is not tolerated because of sexual side effects. • In general, the combined use of spironolactone and adequate doses of a thiazide diuretic or a thiazide-like agent such as chlorthalidone for the treatment of resistant hypertension maximizes efficacy and reduces the risk of spironolactone-induced hyperkalemia.

Publication types

  • Review

MeSH terms

  • Dose-Response Relationship, Drug
  • Humans
  • Hyperkalemia / chemically induced
  • Hypertension / drug therapy*
  • Mineralocorticoid Receptor Antagonists* / adverse effects
  • Mineralocorticoid Receptor Antagonists* / therapeutic use*
  • Sexual Dysfunction, Physiological / chemically induced
  • Sodium Channel Blockers / adverse effects
  • Sodium Channel Blockers / therapeutic use*
  • Treatment Outcome


  • Mineralocorticoid Receptor Antagonists
  • Sodium Channel Blockers