The evolution of aldosterone antagonists

Since the isolation and purification of aldosterone from adrenal extracts 50 years ago (Experientia 9 (1953) 33), scientists have learned a great deal about how and where aldosterone acts, the factors that control its release, what is its role in the pathophysiology of cardiovascular disease. how to make and study aldosterone antagonists, and for what medical purposes these agents are useful. In this paper, we will discuss the evolution of aldosterone antagonists from the relatively nonselective spironolactone (Aldactone(R)), to the highly selective eplerenone (Inspra(R)). Eplerenone represents a molecule with improved steroid receptor selectivity and pharmacokinetic properties ill man compared to spironolactone. Recent clinical results have demonstrated that these improvements translate into tolerability and efficacy in patients with cardiovascular disease. (C) 2003 Elsevier Ireland Ltd. All rights reserved.