Aldosterone Excess or Escape: Treating Resistant Hypertension

Authors

  • Samira Ubaid-Girioli MD, PhD,

    1. From the Section of Cardiovascular Pharmacology and Hypertension, Department of Pharmacology,
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  • Leoní Adriana De Souza PharmD, PhD,

    1. From the Section of Cardiovascular Pharmacology and Hypertension, Department of Pharmacology,
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  • Juan Carlos Yugar-Toledo MD, PhD,

    1. From the Section of Cardiovascular Pharmacology and Hypertension, Department of Pharmacology,
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  • Luiz Cláudio Martins MD, MSc,

    1. From the Section of Cardiovascular Pharmacology and Hypertension, Department of Pharmacology,
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  • Sílvia Ferreira-Melo PharmD, PhD,

    1. From the Section of Cardiovascular Pharmacology and Hypertension, Department of Pharmacology,
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  • Otávio Rizzi Coelho MD, PhD,

    1. the Department of Internal Medicine, Cardiology Unit,
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  • Cristina Sierra MD, PhD,

    1. Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil; the Hypertension Unit, Department of Internal Medicine, Hospital Clinic, School of Medicine, University of Barcelona, Barcelona, Spain;
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  • Antonio Coca MD, PhD,

    1. Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil; the Hypertension Unit, Department of Internal Medicine, Hospital Clinic, School of Medicine, University of Barcelona, Barcelona, Spain;
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  • Eduardo Pimenta MD,

    1. the Endocrine Research Centre and Clinical Centre of Research Excellence in Cardiovascular Disease and Metabolic Disorders, University of Queensland School of Medicine, Princess Alexandra Hospital, Brisbane, Australia
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  • Heitor Moreno MD, PhD

    1. From the Section of Cardiovascular Pharmacology and Hypertension, Department of Pharmacology,
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Heitor Moreno, MD, PhD, Cardiovascular Pharmacology and Hypertension Division, Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), PO Box 6111, 13083-970, Campinas, São Paulo, Brazil
E-mail: hmoreno@uol.com.br

Abstract

Aldosterone excess or “escape” can occur after treatment with medications that block the renin-angiotensin-aldosterone system or in undiagnosed primary aldosteronism. Spironolactone is thought to be an important addition to resistant hypertension (RH) treatment. In this study, resistant (RH) and controlled (CH) hypertensives and normotensive patients were submitted to echocardiography, flow-mediated vasodilation, carotid intima-media wall thickness studies, renin plasma activity, and aldosterone plasma levels and plasma and urinary sodium and potassium concentrations at baseline (pre-spironolactone phase). Subsequently, for only RH and CH groups, 25 mg/d spironolactone was added to preexisting treatments over 6 months. Afterwards, these parameters were reassessed (post-spironolactone phase). The RH and CH groups achieved reductions in blood pressure (P<.001), decreases in left ventricular hypertrophy (P<.001), improved diastolic function (Kappa index RH: 0.219 and Kappa index CH: 0.392) and increases in aldosterone concentrations (P<.05). The RH group attained improved endothelium-dependent (P<.001) and independent (P=.007) function. Optimized RH treatment with spironolactone reduces blood pressure and improves endothelial and diastolic function and left ventricular hypertrophy despite the presence of aldosterone excess or escape.

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