| Normokalemic hyperaldosteronism in patients with resistant hypertension. | |
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MedLine Citation:
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PMID: 11802302 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Primary aldosteronism is a common cause of non-renal secondary hypertension. A correct diagnosis results in curing the hypertension or targeting appropriate pharmacotherapy. In patients with low renin resistant hypertension (after treatment with three or more different anti-hypertensive drugs the blood pressure remains above 140/90 mmHg), screening for aldosteronism is mandatory. OBJECTIVES: To demonstrate that normal blood levels of potassium in resistant hypertensive patients do not exclude the possible presence of hyperaldosteronism, and to suggest the use of the plasma aldosterone concentration (ng/dl)/plasma renin activity (ng/ml/hour) ratio in screening for hyperaldosteronism. METHODS: Blood tests, suppression and stimulation tests (2 L normal saline i.v./4 hours and 20 mg furosemide i.v. for 60 minutes in a standing position) were systematically performed in 20 low renin normokalemic resistant hypertensive patients. None had renal disorders, known endocrine abnormalities or heart failure. They did not receive anti-hypertensive drugs affecting PAC or PRA. Basal PRA and PAC were measured twice: PAC after saline infusion and PAC/PRA after stimulation. RESULTS: PAC/PRA above 50 was used to denote hyperaldosteronism. Serum K was 4 +/- 0.07 mM/L, PAC 22.8 +/- 1.8 ng/dl, PRA 0.13 +/- 0.02 ng/ml/hour, PAC/PRA 190 +/- 22 (above 100 in 17). After suppression PAC decreased from 25 +/- 1.8 to 11 +/- 1 ng/dl (normal < 5 ng/dl). Stimulation did not affect PRA and PAC/PRA. Abdominal computed tomography scan revealed normal adrenal glands in 15 patients. Spironolactone (116 +/- 60 mg/day) normalized blood pressure in all patients; it was used as a single therapy in 8, and in association with only one anti-hypertensive drug in the remaining 12 patients. In one patient the treatment was discontinued due to the presence of hyperkalemia. CONCLUSIONS: Low renin resistant hypertension associated with normokalemia may be due to hyperaldosteronism. Normal aldosterone levels in the basal condition do not exclude the possibility of hyperaldosteronism. Using a PAC/PRA ratio above 50 as a screening test can aid the physician in deciding when to perform dynamic tests, thus increasing the sensitivity of the diagnosis of hyperaldosteronism. CT scan is frequently normal. Targeted pharmacotherapy leads to a normalization of blood values. |
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Authors:
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Sydney Benchetrit; Jacques Bernheim; Eduardo Podjarny |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Israel Medical Association journal : IMAJ Volume: 4 ISSN: 1565-1088 ISO Abbreviation: Isr. Med. Assoc. J. Publication Date: 2002 Jan |
Date Detail:
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Created Date: 2002-01-22 Completed Date: 2002-02-08 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 100930740 Medline TA: Isr Med Assoc J Country: Israel |
Other Details:
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Languages: eng Pagination: 17-20 Citation Subset: IM |
Affiliation:
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Department of Nephrology, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel. drsidney@inter.net.il |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aldosterone / blood* Aldosterone Antagonists / therapeutic use Analysis of Variance Antihypertensive Agents / therapeutic use Creatinine / blood Female Humans Hyperaldosteronism / blood*, complications*, drug therapy Hypertension / blood*, drug therapy, etiology* Hypokalemia / blood*, complications* Male Middle Aged Potassium / blood* Renin / blood* Retrospective Studies Sensitivity and Specificity Spironolactone / therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Aldosterone Antagonists; 0/Antihypertensive Agents; 52-01-7/Spironolactone; 52-39-1/Aldosterone; 60-27-5/Creatinine; 7440-09-7/Potassium; EC 3.4.23.15/Renin |
| Comments/Corrections | |
Comment In:
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Isr Med Assoc J. 2002 Jan;4(1):32-3
[PMID:
11802308
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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