[New potentialities in the treatment of idiopathic hyperaldosteronism]

The study was undertaken to examine whether the drugs affecting the renin-angiotensin system may be used in the combined treatment of patients with idiopathic hyperaldosteronism (IHA). The study covered 20 patients (mean age 46.6 +/- 7.3 years). The diagnosis in all the patients was verified by a complex of instrumental studies, including the determination of plasma aldosterone concentrations (PAC) and plasma renin activity (PRA), and topical diagnostic studies (ultrasonography, computed tomography (CT)/magnetic resonance imaging (MRI), and angiography). The patients were given spironolactone, dihydropyridine calcium blockers, and beta-adrenoblockers, then with the cross-over method, this combination was added by the angiotensin-I receptor blocker (ATRB) losartane or the angiotensin-converting enzyme inhibitor (ACEI) lisinopril for 4 weeks. 24-hour blood pressure (BP) monitoring was used to evaluate the efficiency of therapy. In the combined therapy losartane, 50-100 mg/day, reduced systolic BP (SBP) by 8.4%, diastolic BP (DBP) by 11.1% while lisinopril, 10-20 mg/day lowered SBP and DBP by 7.6 and 9.9%, respectively. Both drugs improved the daily BP profile. When losartane or lisinopril added to the combined treatment, a therapeutic response was achieved in 15 (79%) and 14 (73.7%) patients, respectively. ARB and ACEI exert an antihypertensive effect in patients with IHA and they may be used in the combined treatment of this disease. The use of the above drugs may reduce the dose of spironolactone to the mean therapeutic one. The pathophysiological rationale for the use of ATRB for IHA is that the sensitivity of aldosterone secretion to the stimulating effect of angiotensin II is preserved despite the fact that the PAC is higher and PRA is lower.