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(eplerenone) is the first selective aldosterone receptor antagonist. It has been used to treat hypertension and left ventricular dysfunction after acute myocardial infarction. It can effectively lower blood pressure, improve cardiac function, and reduce myocardial damage. The chemical formula of eplerenone (EPL) is 9,11-epoxy-17-hydroxy-3-oxo-γ-lactone-4-pregnene-7,21-dicarboxylic acid methyl ester.

The combination of eplerenone and enalapril can significantly reduce left ventricular weight, and the addition of hydrochlorothiazide and amlodipine can further reduce it. Previous studies have confirmed that left ventricular mass index is associated with event-free survival. In studies on patients with diabetes mellitus and proteinuria, both eplerenone and enalapril can reduce systolic blood pressure and diastolic blood pressure, but eplerenone reduces the urinary albumin/inosine ratio UACR more significantly than enalapril.

Aldosterone has a variety of pathophysiological effects, including causing central hypertension, accelerating endothelial damage (catecholamines enhance its effects), reducing heart rate variability, inducing ventricular arrhythmia, promoting sodium retention, potassium and magnesium loss, promoting myocardial fibrosis, necrosis and inflammation, and damaging the fibrinolytic system.

Eplerenone selectively acts on aldosterone receptors and is highly selective for mineralocorticoid receptors, but has less effect on androgen and progesterone receptors. Its affinity for mineralocorticoids is 15 to 20 times that of spironolactone, while its affinity for androgen and progesterone receptors is 500 times smaller than that of spironolactone, so sex hormone-related adverse reactions are less likely to occur.

It is understood that eplerenone is not currently on the market in my country, so there is no issue of medical insurance reimbursement. Even if it is sold in Hong Kong and Taiwan, mainland residents cannot use medical insurance.

Generic drugs produced in India are widely popular among Chinese patients. Since there are no high research and development costs, India's Lupine Pharmaceuticals' eplerenone, 50mg*100 tablets, is priced at about RMB 500, which will not cause excessive financial burden to patients and is a very suitable choice.