THE JOURNAL OF CLINICAL HYPERTENSION VOL. VI NO. VIII AUGUST 2004470
antagonist that is not associated with endocrine side effects, spironolactone should still be the aldosterone antagonist of first choice for the treatment of heart failure or hypertension because it has well document-ed efficacy and is less costly. Nevertheless, if gyne-comastia or other troubling endocrine side effects develop with the use of spironolactone, eplerenone would be an appropriate substitute.
REFERENCES 1 Pitt B, Zannad F, Remme WJ, et al. The effect of spirono-
lactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341(10):709717.
2 Rose LI, Underwood RH, Newmark SR, et al. Pathophysiology of spironolactone-induced gynecomastia. Ann Intern Med. 1977;87(4):398403.
3 Moore TD, Nawarskas JJ, Anderson JR. Eplerenone: a selective aldosterone receptor antagonist for hypertension and heart failure. Heart Dis. 2003;5(5):354363.
4 Pitt B, Remme W, Zannad F, et al. Eplerenone, a selec-tive aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003;348(14):13091321.
5 Jessup M. Aldosterone blockade and heart failure. N Engl J Med. 2003;348(14):13801382.
Table. Antihypertensive Medications Associated With Gynecomastia
Potassium sparing diuretics
Calcium channel blockers
Angiotensin-converting enzyme inhibitors
Alpha receptor blockers
Centrally acting agents
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