Spironolactone, an aldosterone antagonist, was used extensively in the management of hypertensive disorders in pregnancy until demasculinisation of the external genitalia of exposed rats was reported by Hecker and colleagues in 1980.
Mineralocorticoid receptor antagonists (MRAs) are highly effective in the management of resistant hypertension and primary aldosteronism. In addition, recent studies have demonstrated that MRAs significantly reduce blood pressure, severity of obstructive sleep apnoea (OSA), and arterial stiffness in patients with resistant hypertension and moderate-severe OSA.
Eplerenone is a selective MRA 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, 100mg/day, there were no teratogenic or demasculinisation effects.
To date the use of eplerenone has been reported in 6 human pregnancies in women with Gitelman syndrome, primary aldosteronism and cardiac failure, of which no teratogenic effects have been seen.
Two cases of resistant hypertension associated with OSA in pregnancy, treated with eplerenone are presented. The potential role of using eplerenone in pregnancy as treatment for resistant hypertension is discussed.