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Aldosterone and refractory hypertension: a prospective cohort study
Michelangelo Sartori1, Lorenzo A Calò, Vania Mascagna
1Clinica Medica 4, Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy.
American Journal of Hypertension
|April 4, 2006
Summary
Elevated aldosterone levels contribute to resistant hypertension, even without diagnosed primary aldosteronism. Identifying these cases allows for targeted therapies to effectively lower blood pressure.
Area of Science:
- Endocrinology
- Nephrology
- Cardiovascular Medicine
Background:
- Resistant hypertension is a prevalent clinical challenge.
- Inappropriate aldosterone activity is a potential contributor to antihypertensive treatment resistance.
Purpose of the Study:
- To evaluate the role of elevated aldosterone activity in patients with resistant hypertension.
- To assess the impact of aldosterone levels on achieving blood pressure control.
Main Methods:
- Patients with elevated aldosterone-to-renin ratio (ARR) and plasma aldosterone were selected.
- Groups included idiopathic aldosteronism (IHA), aldosterone-associated hypertension (AAH), and essential hypertension (EH) controls.
- Treatment followed WHO guidelines, with blood pressure <140/90 mm Hg as the endpoint.
Main Results:
- Fewer patients with IHA (41.4%) and AAH (38.5%) reached the blood pressure target compared to EH (54.0%).
- Survival analysis indicated longer time to reach the endpoint for IHA and AAH patients versus EH.
- IHA and AAH groups exhibited higher diastolic blood pressure at follow-up.
Conclusions:
- Elevated plasma aldosterone levels are associated with resistant hypertension, irrespective of diagnosed primary aldosteronism.
- Identifying patients with high aldosterone activity is crucial for effective blood pressure management.
- Targeted therapeutic strategies can improve blood pressure reduction in these patients.
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