Spironolactone reduces blood pressure and albuminuria of obese hypertensive patients with Metabolic Syndrome

Abstract

Fundação IMEPEN CAPES.Introdução: A aldosterona tem sido implicada na fisiopatologia da síndrome metabólica (SM), assim como da hipertensão arterial a ela associada; entretanto, o uso de antagonistas do receptor mineralocorticoide neste grupo de indivíduos foi pouco estudado. Objetivos: Avaliar os efeitos do bloqueio mineralocorticoide no comportamento pressó-rico, em parâmetros metabólicos, inflamatórios e renais de indivíduos com SM. Métodos: Vinte e nove indivíduos com SM foram avaliados em estudo prospectivo que consistiu de dois períodos: basal (duas semanas), no qual foram obtidos dados demográficos e suspensa a medicação anti-hipertensiva, e período de tratamento, no qual foi administrada espironolactona (25 a 50 mg/dia), por 16 semanas. Em ambos os períodos, foram avaliados marcadores inflamatórios, metabólicos e renais, além da realização da monitorização ambulatorial da pressão arterial. Resultados: Após tratamento com espironolactona, a pressão arterial sistólica e diastólica de 24 horas reduziu de 143,5 ± 15,17 mmHg para 133,2 ± 17,34 mmHg (p = 0,025) e de 85,2 ± 11,10 mmHg para 79,3 ± 11,78 mmHg (p = 0,026), respectivamente. Os níveis de colesterol HDL aumentaram de 44,0 ± 8,67 para 49,0 ± 6,75mg/dL (p = 0,000) e a proteína C reativa reduziu significantemente de 6,3 ± 7,54 mg/L para 4,6 ± 6,30 mg/L. Os níveis de glicemia de jejum, insulina, HOMA-IR e triglicérides não apresentaram alteração significante após bloqueio do receptor mineralocorticoide. A filtração glomerular estimada não se alterou, enquanto o logaritmo da albuminúria reduziu significantemente de 2,5 ± 0,92 para 2,0 ± 0,95. Conclusão: A administração de espironolactona em monoterapia a hipertensos com SM foi Introduction: In recent years, a role for aldosterone in pathophysiology of metabolic syndrome and hypertension in this syndrome has been suggested. However, the treatment with antagonists of mineralocorticoid receptor in these individuals has not properly addressed. Objective: To evaluate the effects of mineralocorticoid receptor blockade on blood pressure, inflammatory, metabolic and renal parameters in non-diabetic hypertensive individuals with the metabolic syndrome. Methods: Twenty nine patients with metabolic syndrome were enrolled in a prospective protocol that consisted of 2 periods: baseline (2 weeks) in which demographic data were obtained and antihypertensive medicines were withdrawn, and treatment period when the individuals were treated with spironolactone 25-50 mg once-a-day, for 16 weeks. In both periods, inflammatory, metabolic and renal parameters were assessed and the 24-hour ambulatory blood pressure monitorization was performed. Results: After spironolactone treatment, 24 hour systolic and diastolic blood pressure decreased from 143.5 ± 15.17 mmHg to 133.2 ± 17.34 mmHg (p = 0.025) and from 85.2 ± 11.10 mmHg to 79.3 ± 11.78 mmHg (p = 0.026), respectively. HDL-cholesterol increased from 44.0 ± 8.67 mg/dl to 49.0 ± 6.75mg/dl (p = 0.000) and C-reactive protein decreased significantly from 6.3 ± 7.54 mg/l to 4.6 ± 6.3...

Features of hemodynamic and metabolic disorders in obese patients with resistant hypertension

“…In most patients, RH can be influenced by optimizing combination antihypertensive therapy to improve compliance and lifestyle correction [1,2]. As indicated in the 2018 ESC/ESH Guidelines [1], in the case of RH, an antagonist of mineralocorticoid receptors should be additionally prescribed to patients, due to its effect on a number of pathogenetic mechanisms such as the suppression of macrophage infiltration and improvement of endothelium-dependent vasodilatation (EDVD) [3][4][5][6]. There is evidence of a more pronounced hypotensive effect of aldosterone blockers in patients with increased waist circumference than in patients with its normal values [7][8][9].…”

Aldosterone and Obesity: Where to Look for the Key to Therapy?

“…et.al. [19] снижение вышеуказанных показателей было достигнуто моно-терапией спиронолактоном, что лишь акцентирует значимость альдостерона в патогенезе АГ у таких пациентов. Имеются данные о более выраженном гипотензивном эффекте блокаторов альдостерона у больных с увеличенной окружностью талии, чем у пациентов с ее нормальными значениями [46,44].…”

“…Однако, что конкретно привело к измене-нию метаболизма липидов -избыток альдостерона или жировой ткани -остается неясным. Эффектив-ность блокаторов альдостерона в улучшении липид-ного профиля подтверждается исследованием порту-гальских ученых [19], где применение спиронолакто-на в дозе 25-50 мг/сут у 29 пациентов с избыточной массой тела привело к повышению уровня ХС ЛПВП с 44,0 ± 8,67 мг/дл до 49,0 ± 6,75 мг/дл (p = 0,001). В то же время результаты крупномасштабного исследова-ния Framingham Heart Study, с участием 2 891 паци-ентов опровергли вышеуказанные данные, не выявив взаимосвязи между уровнем ЛПВП и альдостероном [33].…”