Hace más de 50 años que conocemos que, en los tejidos epiteliales, la aldosterona produce retención de Na+ y agua, y pérdida de K+ y Mg2+. Sin embargo, la aldosterona ejerce también importantes acciones extrarrenales, mediadas por la activación de los receptores mineralocorticoideos presentes en corazón, cerebro y vasos. Recientemente se ha demostrado, tanto de manera experimental como en la práctica clínica, que la aldosterona es un factor de riesgo independiente para el desarrollo de enfermedades cardiovasculares. De hecho, unas concentraciones elevadas de aldosterona se relacionan con un efecto deletéreo en el sistema cardiovascular, que contribuye al desarrollo de disfunción endotelial, fibrosis, hipertrofia e inflamación, insuficiencia cardiaca, activación simpática, ictus y disfunción renal. Además, se ha demostrado que el tratamiento con antagonistas de los receptores mineralocorticoideos reduce el daño progresivo que la aldosterona produce en los órganos diana de pacientes con hipertensión o insuficiencia cardiaca. La eplerenona es un nuevo antagonista específico de los receptores mineralocorticoideos que ha sido aprobado para el tratamiento de pacientes con disfunción sistólica ventricular izquierda y evidencia clínica de insuficiencia cardiaca tras infarto de miocardio. Comparada con la espironolactona, la eplerenona presenta una mayor selectividad por los receptores mineralocorticoideos que por otros receptores esteroideos y mejora las propiedades farmacocinéticas de aquélla. Esta revisión analiza, en primer lugar, la síntesis, la liberación y el mecanismo de acción de la aldosterona y, posteriormente, el mecanismo de acción, las propiedades farmacocinéticas y farmacodinámicas y la tolerabilidad de la eplerenona.
Palabras clave
Eplerenona
Mecanismo de acción
Aldosterona
Farmacología
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