Gehlert Jessica, Morton Adam
Clinical Pharmacology Department, Royal Adelaide Hospital, South Australia, Australia.
Obstetric Medicine and Endocrinology, Mater Health, Brisbane, Queensland, Australia.
Obstet Med. 2021 Mar;14(1):35-38. doi: 10.1177/1753495X19825967. Epub 2019 Mar 24.
Mineralocorticoid receptor antagonists are highly effective in the management of resistant hypertension and primary hyperaldosteronism. Recent studies demonstrate that mineralocorticoid receptor antagonists significantly reduce blood pressure, severity of obstructive sleep apnoea and arterial stiffness in patients with resistant hypertension and moderate-severe obstructive sleep apnoea. Eplerenone is a selective mineralocorticoid receptor antagonist that does not act as an androgen receptor blocker, thus reducing the risk of fetal anti-androgenic effects. Rat and rabbit studies demonstrated that when exposed to 30 times the equivalent therapeutic human dose, 100 mg/day, there were no teratogenic or demasculinisation effects. To date, the use of eplerenone has been reported in six human pregnancies in women with Gitelman syndrome, primary hyperaldosteronism and cardiac failure, in which no teratogenic effects were seen. Described here is a case of resistant hypertension associated with obstructive sleep apnoea in pregnancy, treated with eplerenone. The potential role of using eplerenone in pregnancy as treatment for resistant hypertension is discussed. Not applicable.
盐皮质激素受体拮抗剂在难治性高血压和原发性醛固酮增多症的治疗中非常有效。最近的研究表明，盐皮质激素受体拮抗剂可显著降低难治性高血压和中度至重度阻塞性睡眠呼吸暂停患者的血压、阻塞性睡眠呼吸暂停的严重程度以及动脉僵硬度。依普利酮是一种选择性盐皮质激素受体拮抗剂，它不会作为雄激素受体阻滞剂起作用，从而降低了胎儿抗雄激素作用的风险。大鼠和兔子研究表明，当暴露于相当于人类治疗剂量30倍（100毫克/天）时，没有致畸或去雄化作用。迄今为止，已有报道在患有吉特林综合征、原发性醛固酮增多症和心力衰竭的6名孕妇中使用依普利酮，未观察到致畸作用。本文描述了一例妊娠合并阻塞性睡眠呼吸暂停的难治性高血压病例，用依普利酮进行了治疗。讨论了在妊娠中使用依普利酮治疗难治性高血压的潜在作用。不适用。
