Clinical applications of antimineralocorticoids

The renin-angiotensin-aldosterone system plays an important role in the development and maintenance of high blood pressure in several forms of hypertension. In hypertensive patients with primary aldosteronism, antimineralocorticoids are, as expected, very effective in reducing blood pressure and correcting metabolic disturbances. In patients with essential hypertension, an abnormal relationship between angiotensin II and aldosterone can occur. Aldosterone secretion in these patients is often too high relative to circulating levels of angiotensin II. Antimineralocorticoids effectively lower blood pressure in a large number of these patients. The reactive hyperreninemia caused by salt depletion is a factor limiting the antihypertensive effect of natriuretic agents including that of antimineralocorticoids. The enhanced aldosterone secretion resulting from treatment with a diuretic other than an antimineralocorticoid may diminish the natriuretic action of that diuretic. Therefore, antimineralocorticoids given in addition to a diuretic enhance natriuresis. The renin-angiotensin-aldosterone system is also involved as a compensatory mechanism in cardiovascular and body fluid homeostasis of patients with severe congestive heart failure or liver cirrhosis with ascites. Antimineralocorticoids are very effective in such conditions. In patients with congestive heart failure treated with digitalis, these natriuretic agents are particularly useful because of their potassium-sparing properties. The risk of developing hyperkalemia during antimineralocorticoid administration is negligible unless renal function is impaired. Antimineralocorticoids have the advantage of exerting no deleterious effect on carbohydrate and lipid metabolism. The use of these agents seems therefore rational in a variety of diseases concerned with blood pressure and body fluid volume regulation.