Efficacy of 4 Weeks Therapy with Eplerenone in Resistant Hypertension: Reduction of Aortic Blood Pressure, Arterial Stiffness, and Impact on IL-6 Levels

Abstract Background Resistant hypertension affects 10–15% of treated patients and remains a therapeutic challenge. Eplerenone is recommended when spironolactone is ineffective or poorly tolerated. Central blood pressure (BP) correlates more strongly with cardiovascular complications than peripheral BP, and pulse wave velocity (PWV) reflects arterial stiffness, a key factor in hypertension-related morbidity. While spironolactone is well-established for resistant hypertension, data on eplerenone’s efficacy and safety for this indication is limited. Interleukin-6 (IL-6) is involved in resistant hypertension and the pressor response to angiotensin II, with elevated levels suggesting its role in aldosterone regulation and potential as a therapeutic target. This study aimed to evaluate the efficacy of eplerenone (25–50 mg/day) on central aortic BP, PWV, office BP, ambulatory BP monitoring (ABPM), and IL-6 levels after four weeks. Twenty-seven patients with confirmed resistant hypertension received eplerenone for four weeks. Office BP, ABPM, central aortic BP, PWV, and safety markers (potassium, creatinine) were measured. IL-6 levels were assessed at baseline and post-treatment. Results Significant reductions were observed in office BP (SBP: −13.93 mmHg, DBP: −7.64 mmHg), aortic BP (SBP: −13.42 mmHg, DBP: −7.94 mmHg), 24 h-ABPM (SBP: −7 mmHg, DBP: −3 mmHg), and PWV (− 1.52 m/s). Doubling the eplerenone dose from 25 mg to 50 mg daily reduces aortic systolic blood pressure threefold. IL-6 levels also decreased significantly ( p = 0.023). Conclusions Eplerenone effectively reduces central and peripheral BP, arterial stiffness, and IL-6 levels, potentially lowering cardiovascular risk in resistant hypertension.