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Role of aldosterone in the antihypertensive effect of spironolactone in essential hypertension
Author(s) -
Benraad H.,
Drayer J.,
Hoefnagels W.,
Kloppenborg P.,
Benraad Th.
Publication year - 1978
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt1978246638
Subject(s) - spironolactone , aldosterone , blood pressure , medicine , plasma renin activity , essential hypertension , endocrinology , hyperaldosteronism , renal function , mineralocorticoid , renin–angiotensin system
In order to evaluate the relationship between aldosterone status and the blood pressure‐lowering effect of spironolactone, 38 patients with essential hypertension were treated with spironolactone (400 mg/day) during one week in hospital on a rigidly sodium‐restricted diet. The degree of hyperaldosteronism was assessed by the aldosterone secretory rate after 5 days of salt loading (315 mmol Na + /day). The mean arterial pressure decreased 5.6% (range, −21 to +8%). When the patients were divided into subgroups with low and normal renin activity, there was no difference in the change in mean arterial pressure (−5.0% and −6.1%). When the patients were divided into three groups with low, normal, and supranormal aldosterone secretory rates, the last group had a significantly greater fall in blood pressure after the spironolactone than the other groups (−1.0, −7.1, −11.1%). Thus there was a correlation between the aldosterone secretory rate after sodium loading and the blood pressure‐lowering effect of spironolactone (r = −0.53, p < 0.01). The blood pressure‐lowering effect was not related to changes in body weight, kidney function, or plasma electrolytes. Our findings do not provide solid arguments for the view that the blood pressure‐lowering effect of high dose spironolactone is due to its antimineralocorticoid activity, but the correlation between the degree of hyperaldosteronism and the blood pressure‐lowering effect strongly suggests that aldosterone does play a role in the genesis or maintenance of the hypertension in these patients.