Resistant Hypertension and Aldosterone: An Update

Abstract Resistant hypertension (RHTN) is defined as a blood pressure remaining above goal despite the concurrent use of 3 antihypertensive medications of different classes, including, ideally a diuretic. RHTN is an important health problem with a prevalence rate expected to increase as populations...

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Bibliographic Details
Published in:Canadian journal of cardiology 2012-05, Vol.28 (3), p.318-325
Main Authors: Clark, Donald, MD, Ahmed, Mustafa I., MD, Calhoun, David A., MD
Format: Article
Language:English
Subjects:
Aldosterone - metabolism
Cardiovascular
Drug Resistance, Multiple
Drug Therapy, Combination
Female
Humans
Hyperaldosteronism - complications
Hyperaldosteronism - drug therapy
Hyperaldosteronism - physiopathology
Hypertension - complications
Hypertension - drug therapy
Hypertension - physiopathology
Male
Prognosis
Risk Assessment
Severity of Illness Index
Sleep Apnea, Obstructive - complications
Sleep Apnea, Obstructive - diagnosis
Sleep Apnea, Obstructive - drug therapy
Spironolactone - therapeutic use
Treatment Outcome
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Summary:Abstract Resistant hypertension (RHTN) is defined as a blood pressure remaining above goal despite the concurrent use of 3 antihypertensive medications of different classes, including, ideally a diuretic. RHTN is an important health problem with a prevalence rate expected to increase as populations become older, more obese, and at higher risk of having diabetes and chronic kidney disease, all of which are important risk factors for development of RHTN. The role of aldosterone has gained increasing recognition as a significant contributor to antihypertensive treatment resistance. In prospective studies, the prevalence of primary aldosteronism (PA) has ranged from 14%-21% in patients with RHTN, which is considerably higher than in the general hypertensive population. Furthermore, marked antihypertensive effects are seen when mineralocorticoid antagonists are added to the treatment regimen of patients with RHTN, further supporting aldosterone excess as an important cause of RHTN. A close association exists between hyperaldosteronism, RHTN, and obstructive sleep apnea (OSA) based upon recent studies which indicate that OSA is worsened by aldosterone-mediated fluid retention. This interaction is supported by preliminary data which demonstrates improvement in OSA severity after treatment with spironolactone.
ISSN:0828-282X
1916-7075
DOI:10.1016/j.cjca.2012.03.010