Hypertension remains a major public health problem, affecting up to 20% of the adult population in Western societies. Despite progress in treatment, the rates of blood pressure control remain suboptimal. Hypertension is a heterogeneous disorder, and in the majority of cases, with so-called "essential" hypertension, no clear single identifiable cause is found. Syndromes of excessive mineralocorticoid production or activity are among the important causes of secondary hypertension. Aldosterone is the principal mineralocorticoid in humans, and primary aldosterone excess, when associated with an aldosterone secreting adenoma (Conns tumor), is amenable to surgical cure. Classically, patient with Conns tumor present with spontaneous hypokalemia and have a relative excess of aldosterone production with suppression of plasma levels of renin (a proxy for angiotensin II, the major trophic substance regulating aldosterone secretion). This combination of a high aldosterone and a low renin is however more commonly associated with nodular hyperplasia of the adrenal glands, a condition not improved by surgery and variably responsive to the effects of mineralocorticoid antagonists such as spironolactone. Although primary aldosteronism was previously considered to be rare, recent studies have reported prevalence rates of up to 20% among hypertensive patients. This reflects the increasing use of the plasma aldosterone concentration to renin activity ratio (ARR), rather than spontaneous hypokalemia, as a screening tool for aldosteronism. Many patients with high ARR have normokalemia and, although renin activity is low, the level of aldosterone is usually within the normal range. This group of patients may thus include those who were previously classified as having low-renin essential hypertension. Recent data suggest that disturbances in aldosterone metabolism and regulation may not be uncommon in patients with essential hypertension. Thus, relatively high serum aldosterone levels within the reference range in normotensive individuals are associated with a substantially increased risk of developing hypertension, highlighting the potential role for aldosterone in the etiology of essential hypertension. The present review addresses the physiology of aldosterone action and its role in the pathogenesis of hypertension. Keywords: renin-angiotensin system (RAS), Potassium, ACTH, Primary Aldosteronism, Essential Hypertension
A patient, who presented with a flaccid quadriplegia due to profound hypokalaemia, is described. Hypokalaemia and myoglobinuria were caused by the ingestion of small amounts of liquorice contained in a laxative preparation. Subsequent controlled administration of small amounts of this preparation induced marked hypokalaemia. This was associated with sodium retention and potassium loss confirming a mineralocorticoid-like action. The sodium retention was associated with suppression of plasma levels of renin and aldosterone.
Systolic and diastolic blood pressure readings from patients using one of two telemonitoring systems: "patient-texted" or "automatic-transmission". See corresponding publication "Are self-reported telemonitored blood pressure readings affected by end digit preference: a prospective cohort study".
O'Brien, Eoin; Asmar, Roland; Beilin, Lawrie; Imai, Yutaka; Mallion, Jean-Michel; Mancia, Giuseppe; Mengden, Thomas; Myers, Martin; Padfield, Paul; Palatini, Paolo; Parati, Gianfranco; Pickering, Thomas; Redon, Josep; Staessen, Jan; Stergiou, George; Verdecchia, Paolo on behalf of the European Society of Hypertension Working Group on Blood Pressure Monitoring Author Information
We set out to test the hypothesis that home blood pressure reflects “baseline” pressures measured at a general practitioner's surgery or in a hospital outpatient clinic. Twenty patients detected hypertensive during screening in general practice and 30 patients referred to a hospital hypertension clinic for revision of therapy were studied. All were instructed in the use of an electronic semiautomatic sphygmomanometer and measured blood pressure at home for a three day period. Home monitored blood pressure correctly predicted those patients whose diastolic blood pressure fell to below 95 mmHg by the third clinic visit in approximately 90% of all patients. In addition, in those whose blood pressure was high at home it remained so at the clinic or surgery after three visits. These data suggest that home monitoring of blood pressure may be a helpful alternative to repeated clinic visits before embarking on medical therapy.
Purpose of review Evidence from clinical trials suggests that refractory hypertension is increasingly common. The underlying mechanisms are largely unknown but recent data have implicated increased aldosterone activity as an important mediator of resistance to routinely used antihypertensive agents. Recent findings Epidemiological studies have suggested a significant rise in the prevalence of primary aldosteronism among patients with hypertension. This reflects the increasing use of an aldosterone-to-renin ratio as a screening tool. Recent reports have demonstrated that relative aldosterone excess is common in individuals with refractory hypertension, and that the use of aldosterone antagonists leads to better blood pressure control in such patients. Summary These data highlight the potential role of aldosterone in the pathogenesis of hypertension. The syndrome of primary aldosteronism, however, encompasses a wide spectrum of disorders that will require better definition. Similarly, although aldosterone blockade is apparently beneficial in individuals with refractory hypertension, this evidence is not currently based on robust randomized, double-blind trial.
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