Mineralocorticoid activity in patients in the early benign phase of essential hypertension

Abstract The major parameters of aldosterone metabolism (daily secretion and excretion rates, metabolic clearance rate and plasma levels) have been measured in carefully selected patients in the early benign phase of essential hypertension and in control subjects by double isotope dilution assay and, more recently, by radioimmunoassay. The results show: (1) a significant mean increase in plasma aldosterone concentration in two different groups of patients in the early benign phase of essential hypertension despite a daily secretion and excretion rate which was found normal in the great majority of patients; (2) a decreased metabolic clearance rate in 80% of all hypertensive patients studied; (3) a decrease in hepatic blood flow as measured by a constant infusion or indocyanine green. These observations are consistent with the absence or the blunting of aldosterone response to a variety of stimuli (severe sodium restriction, furosemide administration, severe hemorrhage) which increase plasma renin activity. Plasma progesterone concentrations are significantly increased in patients in the early phase of benign essential hypertension and their response to severe sodium restriction is significantly smaller than that of normal subjects. These studies indicate definite disturbances in aldosterone metabolism and regulations in the early benign phase of essential hypertension.