Premium
Spironolactone and amiloride in hypertensive patients with and without aldosterone excess
Author(s) -
Hoefnagels Willibrord H L,
Drayer Jan I M,
Smals Anthony G H,
Kloppenborg Peter W C
Publication year - 1980
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 - 10.1038/clpt.1980.42
Subject(s) - amiloride , spironolactone , aldosterone , diuretic , endocrinology , medicine , mineralocorticoid , blood pressure , excretion , sodium , chemistry , organic chemistry
The antihypertensive action of spironolactone has been ascribed to both a nonspecific diuretic and a specific antimineralocorticoid effect. To better evaluate the relative importance of these effects, we compared its effects with the mineralocorticoid‐independent drug amiloride. Spironolactone (400 mg/day) and amiloride (40 mg/day) were given to 10 patients with essential hypertension (EH) and to 10 patients with hypertension and supranormal aldosterone secretion (SNA). After 6 wk, blood pressure responded better to spironolactone (−20.5%) than to amiloride (− 10.4%) in patients with SNA, but the response was similar in patients with EH (−7.4% and −6.5%). The decrease in body weight—as a measure of volume depletion—was greater after spironolactone (−4.6%) than after amiloride both in patients with SNA (−4.6% and −0.8%) and in patients with EH (−3.7% and −0.6%). After both drugs, plasma sodium decreased (−3.4% and −2.6%) and plasma potassium increased (+37.2% and +32.6%) to the same extent in patients with SNA, reflecting a similar degree of antimineralocorticoid‐like activity. After spironolactone patients with SNA showed a greater rise in PRA than after amiloride (412% and 82%). Despite the greater rise in PRA, the rise in aldosterone excretion was in the same range after both drugs (113% and 195%), pointing to inappropriately low aldosterone excretion after treatment with spironolactone. We conclude that differences in volume depletion or antimineralocorticoid‐like activity cannot explain the better response in blood pressure of patients with SNA after spironolactone than after amiloride. Our data provide evidence for a specific antialdosterone effect of spironolactone in lowering the blood pressure, especially in patients with aldosterone excess. Clinical Pharmacology and Therapeutics (1980) 27, 317–323; doi: 10.1038/clpt.1980.42