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Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
08:35

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion

Published on: May 26, 2022

Aldosterone escape during angiotensin-converting enzyme inhibitor therapy in essential hypertensive patients with

A Sato1, T Saruta

  • 1Department of Internal Medicine, Mito Red Cross Hospital, Ibaraki, Japan.

The Journal of International Medical Research
|March 30, 2001
PubMed

Insights

Aldosterone escape, a lack of aldosterone reduction, is common during angiotensin-converting enzyme (ACE) inhibitor therapy for hypertension. This phenomenon may negate ACE inhibitors' positive effects on left ventricular hypertrophy.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Continuous angiotensin-converting enzyme (ACE) inhibitor therapy is a cornerstone treatment for hypertension.
  • However, some patients experience 'aldosterone escape,' where plasma aldosterone levels fail to decrease significantly despite ACE inhibitor use.
  • The clinical implications of aldosterone escape, particularly concerning cardiovascular remodeling, require further investigation.

Purpose of the Study:

  • To investigate the incidence and clinical significance of aldosterone escape in patients with essential hypertension treated with ACE inhibitors.
  • To determine whether aldosterone escape impacts left ventricular hypertrophy (LVH) in these patients.

Main Methods:

  • A prospective study involving 75 patients with essential hypertension treated with enalapril maleate, imidapril hydrochloride, or trandolapril for 40 weeks.
  • Measurements included blood pressure, plasma renin activity, plasma aldosterone concentrations, and left ventricular mass index (LVMI).
  • Patients were categorized based on the presence or absence of aldosterone escape.

Main Results:

  • ACE inhibitor treatment effectively lowered blood pressure and increased plasma renin activity, but plasma aldosterone concentrations remained unchanged in the overall cohort.
  • Aldosterone escape was observed in 38 out of 75 patients (50.7%).
  • Patients with aldosterone escape showed no significant change in LVMI, whereas those without aldosterone escape exhibited a significant decrease in LVMI.

Conclusions:

  • Aldosterone escape occurs frequently in patients with essential hypertension receiving continuous ACE inhibitor therapy.
  • Aldosterone escape may counteract the beneficial effects of ACE inhibitors on left ventricular hypertrophy.
  • These findings highlight the importance of monitoring aldosterone levels and considering alternative or add-on therapies in patients experiencing aldosterone escape.

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