Figure 1 Renal sites of action of diuretics. G, glomerulus; PCT, proximal convoluted tubules; ALHL, ascending limb of Henle's loop; DCT, distal convoluted tubules; CD, collecting duct.

The aldosterone antagonists spironolactone and eplerenone (Table 1) have natriuretic, K+-sparing, and antihypertensive effects. They inhibit the competitive binding of aldosterone to cytoplasmic mineralocorticoid receptors in the late distal tubules and collecting duct. Eplerenone is more selective for mineralocorticoid receptors and has lower affinity for androgen and progesterone receptors than spironolactone.23 The antihypertensive activity of eplerenone was established in numerous clinical trials. Its efficacy was found to be independent of baseline aldosterone levels, age, race, or gender. In addition to its diuretic and antihypertensive effects, eplerenone has a cardioprotective effect: it prolongs survival in patients with heart failure secondary to myocardial infarction.24 Daily doses, bioavailability, and elimination half-life of commonly used diuretics are listed in Table 1.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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