Does Aldosterone-to-Renin Ratio Predict the Antihypertensive Effect of the Aldosterone Antagonist Spironolactone?

Mahmud, Azra; Mahgoub, Mohammed; Hall, Mary; Feely, J.

doi:10.1016/j.amjhyper.2005.06.010

Cited by 62 publications

(46 citation statements)

References 14 publications

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“…Mamhud et al (39) evaluated the BP response to adding 50 mg of spironolactone to patients whose BP was uncontrolled on three agents. At 14 wk of follow-up, the mean BP reduction was 28 Ϯ 3/13 Ϯ 2 mmHg.…”

Section: Aldosterone Antagonists and Treatment Of Resistant Hypertensionmentioning

confidence: 99%

Aldosteronism and Hypertension

Calhoun¹

2006

Clinical Journal of the American Society of Nephrology

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A growing body of evidence suggests that hyperaldosteronism contributes significantly to the development and the severity of hypertension as well as to resistance to antihypertensive treatment. In cross-sectional analyses, plasma aldosterone levels have been shown to relate to BP levels, particularly in obese individuals. In these same individuals, BP was not related to plasma renin activity, suggesting an effect of aldosterone on BP independent of renin-angiotensin II. In a recent prospective analysis from the Framingham investigators, baseline serum aldosterone was strongly associated with development of hypertension during a 4-yr follow-up.Clin J Am Soc Nephrol 1: 1039 -1045 , 2006 . doi: 10.2215 H istorically, primary aldosteronism has been thought to be an uncommon cause of hypertension. Recent studies, however, suggest that 10 to 15% of individuals with hypertension fulfill the biochemical criteria for primary aldosteronism. Demonstration of such a high prevalence of primary aldosteronism in patients with presumed primary hypertension suggests that aldosterone excess is a common contributing cause to the development of hypertension.Primary aldosteronism is particularly common in patients with resistant hypertension, with prevalence of approximately 20%. An important role of hyperaldosteronism in contributing to the development of treatment resistance is suggested further by the broad antihypertensive benefit of aldosterone antagonists as add-on therapy in patients who are resistant to multidrug regimens. The antihypertensive benefit in this setting is not limited to patients with classically defined primary aldosteronism, suggesting aldosterone excess as a cause of resistant hypertension to a degree that is greater than is indicated by measurement of either plasma or urinary aldosterone levels. Aldosterone and Incident HypertensionMultiple, independent studies suggest that aldosterone contributes broadly to the development of hypertension separate from cases of classically defined primary aldosteronism. The role of aldosterone in causing hypertension is supported by cross-sectional studies that relate plasma aldosterone levels to ambulatory BP measurements, by prospective analyses that indicate that aldosterone levels predict development of hypertension, and by studies that confirm the broad antihypertensive efficacy of aldosterone antagonists in treating presumed primary hypertension. Importantly, in these studies, indices of renin activity were not related to BP levels, suggesting an autonomous role of aldosterone in causing hypertension that is independent of renin-angiotensin II.Cross-sectional studies demonstrate a significant correlation between plasma aldosterone and 24-h ambulatory BP levels. The relation is particularly strong in black individuals. In an analysis of black American and white French Canadian patients with primary hypertension, supine and standing plasma aldosterone levels were significantly correlated with daytime and nighttime systolic and diastolic BP levels in the black patients...

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Section: Aldosterone Antagonists and Treatment Of Resistant Hypertensionmentioning

confidence: 99%

Aldosteronism and Hypertension

Calhoun¹

2006

Clinical Journal of the American Society of Nephrology

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“…4 Goodfriend also alludes to the fact that there was no pretreatment measurement of aldosterone or renin. In our study 3 for individuals commencing spironolactone as a first line antihypertensive therapy, age and pretreatment renin and ARR were good predictors of BP reduction. However, in the setting of individuals with resistant hypertension on multiple agents, neither renin nor ARR was a predictor of the hypotensive response.…”

Section: Spironolactone In Resistant Hypertensionmentioning

confidence: 87%

Spironolactone in Resistant Hypertension

Feely

Mahmud

2007

Hypertension

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“…Although there are some data to suggest that a high ARR, a suppressed PRA, 24 and/or a low serum potassium level 19,25 predict a favorable response to aldosterone blockade, such predictive value has not been definitively established in blinded studies that included active comparators, and in fact, was specifically absent in the multicenter studies leading to approval of eplerenone, at least in patients already receiving an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. 26 Accordingly, it is premature to recommend using the ARR to guide preferential use of mineralocorticoid receptor antagonists.…”

Section: Screening For Pamentioning

confidence: 99%

“…The value is not in initiating therapy with a mineralocorticoid receptor antagonist, because, interestingly, we and others have found that the blood pressure response to aldosterone blockade in patients being treating for resistant hypertension is not predicted by the ARR, PRA, or by urinary or plasma aldosterone levels. 18,24 This lack of predictive value is likely in part a consequence of confounding effects of ongoing treatment but also suggests a role of aldosterone in contributing to treatment resistance that is not reflected in the measurement of circulating levels.…”

Section: Screening For Pamentioning

confidence: 99%