Document Detail


Impact of aldosterone receptor blockade compared with thiazide therapy on sympathetic nervous system function in geriatric hypertension.
MedLine Citation:
PMID:  20368505     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Aldosterone receptor blockade and thiazide therapy effectively lower blood pressure in geriatric hypertension. Their impact on sympathetic nervous system function has not been evaluated. In a double-blind, randomized study, 36 patients with stage 1 hypertension underwent 6 months of therapy with either aldosterone receptor blockade (spironolactone, n=19; 68+/-1 years) or hydrochlorothiazide (n=17; 68+/-2 years). Arterial blood pressure, [(3)H]-norepinephrine (NE) kinetics (extravascular NE release rate), and alpha-adrenergic responsiveness (forearm vasoconstriction to graded intrabrachial artery NE infusions) were evaluated at baseline, after a 4-week antihypertensive medication withdrawal, and after spironolactone or hydrochlorothiazide treatment. Arterial blood pressure decreased significantly with both spironolactone (160+/-3 to 134+/-2 mm Hg; 77+/-2 to 68+/-2 mm Hg) and hydrochlorothiazide (161+/-4 to 145+/-4 mm Hg; 78+/-2 to 73+/-2 mm Hg) treatment. Sympathetic nervous system activity was significantly reduced after spironolactone (plasma NE: 378+/-40 to 335+/-20 pg/mL, P=0.04; [(3)H]-NE release rate: 2.74+/-0.3 to 1.97+/-0.2 microg/min per meter squared, P=0.04) but not hydrochlorothiazide (plasma NE: 368+/-25 to 349+/-23 pg/mL, P=0.47; [(3)H]-NE release rate: 2.63+/-0.4 to 2.11+/-0.2 mg/min per meter squared, P=0.21). alpha-Adrenergic responsiveness was unchanged with either drug treatment. These findings demonstrate a beneficial effect of aldosterone receptor blockade on reducing sympathetic nervous system activity and blood pressure in hypertensive older patients.
Authors:
D Walter Wray; Mark A Supiano
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2010-04-05
Journal Detail:
Title:  Hypertension     Volume:  55     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-15     Completed Date:  2010-05-28     Revised Date:  2012-10-09    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1217-23     Citation Subset:  IM    
Affiliation:
Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, USA. walter.wray@hsc.utah.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Aldosterone / blood
Aldosterone Antagonists / therapeutic use*
Blood Pressure / drug effects*
Body Composition
Catecholamines / blood
Diuretics / therapeutic use
Female
Heart Rate / drug effects
Humans
Hydrochlorothiazide / therapeutic use*
Hypertension / blood,  drug therapy,  physiopathology*
Lipoproteins, HDL / blood
Lipoproteins, LDL / blood
Male
Middle Aged
Norepinephrine / blood
Patient Selection
Receptors, Aldosterone / antagonists & inhibitors*
Spironolactone / therapeutic use*
Sympathetic Nervous System / drug effects,  physiopathology*
Grant Support
ID/Acronym/Agency:
K07 AG 28403/AG/NIA NIH HHS; K07 AG028403-01A1/AG/NIA NIH HHS; K07 AG028403-05/AG/NIA NIH HHS; K24 AG000924-01/AG/NIA NIH HHS; M01-RR00042/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Aldosterone Antagonists; 0/Catecholamines; 0/Diuretics; 0/Lipoproteins, HDL; 0/Lipoproteins, LDL; 0/Receptors, Aldosterone; 51-41-2/Norepinephrine; 52-01-7/Spironolactone; 52-39-1/Aldosterone; 58-93-5/Hydrochlorothiazide
Comments/Corrections
Comment In:
Hypertension. 2010 May;55(5):1090-1   [PMID:  20368501 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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