Gynecomastia and Antihypertensive Therapy

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  • VOL. VI NO. VIII AUGUST 2004 THE JOURNAL OF CLINICAL HYPERTENSION 469

    Gynecomastia is listed as a rare side effect of numerous antihypertensive medications (Table). It occurs in

  • 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

    COMMONLY ASSOCIATED

    Potassium sparing diuretics

    Spironolactone

    RARELY ASSOCIATED

    Calcium channel blockers

    Nifedipine

    Amlodipine

    Diltiazem

    Verapamil

    Angiotensin-converting enzyme inhibitors

    Captopril

    Enalapril

    Alpha receptor blockers

    Doxazosin

    Prazosin

    Centrally acting agents

    Clonidine

    Methyldopa

    Reserpine

    The Journal of Clinical Hypertension (ISSN 1524-6175) is published monthly by Le Jacq Communications, Inc., Three Parklands Drive, Darien, CT 06820-3652. Copyright 2004 by Le Jacq Communications, Inc., All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publishers. The opinions and ideas expressed in this publication are those of the authors and do not necessarily reflect those of the Editors or Publisher. For copies in excess of 25 or for commercial purposes, please contact Sarah Howell at showell@lejacq.com or 203.656.1711 x106.