Skip to main content
SpringerLink
Log in

Resistant hypertension and aldosteronism

  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Resistant hypertension is defined as blood pressure that remains uncontrolled despite using at least three antihypertensive medications in effective doses, ideally including a diuretic. Stricter blood pressure goals, higher obesity rates, older age, and increased use of certain exogenous substances are related to an increasing prevalence of resistant hypertension. The evaluation of patients with resistant hypertension focuses on identifying contributing factors and secondary causes of hypertension including hyperaldosteronism, obstructive sleep apnea, renal artery stenosis, and pheochromocytoma. Hyperaldosteronism is now recognized as the most common secondary cause and all patients with resistant hypertension should be screened with a plasma aldosterone-renin ratio even if the serum potassium level is normal. Treatment includes reversal of contributing factors, appropriate treatment of secondary causes, and use of effective multidrug regimens. Recent studies indicate that the addition of spironolactone to standard treatment regimens induces significant blood pressure reduction in patients with resistant hypertension.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Chobanian AV, Bakris GL, Black HR, et al.: Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003, 42:1206–1252.

    Article  PubMed  CAS  Google Scholar 

  2. Hajjar I, Kotchen TA: Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA 2003, 290:199–206.

    Article  PubMed  Google Scholar 

  3. Cushman WC, Ford CE, Cutler JA, et al.: Success and predictors of blood pressure control in diverse North American settings: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin Hypertens 2002, 4:393–404.

    Article  Google Scholar 

  4. Pepine CJ, Handberg EM, Cooper-DeHoff RM, et al.: A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease—the International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial. JAMA 2003, 290:2805–2816.

    Article  PubMed  CAS  Google Scholar 

  5. Conn JW: Presidential address. I. Painting background. II. Primary aldosteronism, a new clinical syndrome. J Lab Clin Med 1955, 45:3–17.

    PubMed  CAS  Google Scholar 

  6. Gordon RD, Ziesak MD, Tunny TJ, et al.: Evidence that primary aldosteronism may not be uncommon: 12% incidence among antihypertensive drug trial volunteers. Clin Exp Pharmacol Physiol 1993, 20:296–298.

    Article  PubMed  CAS  Google Scholar 

  7. Gordon RD, Stowasser M, Tunny TJ, et al.: High incidence of primary aldosteronism in 199 patients referred with hypertension. Clin Exp Pharmacol Physiol 1994, 21:315–318.

    Article  PubMed  CAS  Google Scholar 

  8. Mosso L, Carvajal C, González A, et al.: Primary aldosteronism and hypertensive disease. Hypertension 2003, 42:161–165.

    Article  PubMed  CAS  Google Scholar 

  9. Calhoun DA, Nishizaka MK, Zaman MA, et al.: Hyperaldosteronism among black and white subjects with resistant hypertension. Hypertension 2002, 40:892–896.

    Article  PubMed  CAS  Google Scholar 

  10. Gallay BJ, Ahmad S, Xu L, et al.: Screening for primary aldosteronism without discontinuing hypertensive medications: plasma aldosterone-renin ratio. Am J Kidney Dis 2001, 37:669–705.

    Article  Google Scholar 

  11. Eide IK, Torjesen PA, Drolsum A, et al.: Low-renin status in therapy-resistant hypertension: a clue to efficient treatment. J Hypertens 2004, 22:2217–2226.

    Article  PubMed  CAS  Google Scholar 

  12. Strauch B, Zelinka T, Hampf M, et al.: Prevalence of primary hyperaldosteronism in moderate to severe hypertension in the Central Europe region. J Hum Hypertens 2003, 17:349–352.

    Article  PubMed  CAS  Google Scholar 

  13. Rocha R, Rudolph AE, Frierdich GE, et al.: Aldosterone induces a vascular inflammatory phenotype in the rat heart. Am J Physiol Heart Circ Physiol 2002, 283:H1802–H1810.

    PubMed  CAS  Google Scholar 

  14. Brilla CG, Weber KT: Mineralocorticoid excess, dietary sodium, and myocardial fibrosis. J Lab Clin Med 1992, 120:893–901.

    PubMed  CAS  Google Scholar 

  15. Sato A, Saruta T: Aldosterone-induced organ damage: plasma aldosterone level and inappropriate salt status. Hypertens Res 2004, 27:303–310.

    Article  PubMed  CAS  Google Scholar 

  16. Rossi GP, Sacchetto A, Visentin P, et al.: Changes in left ventricular anatomy and function in hypertension and primary aldosteronism. Hypertension 1996, 27:1039–1045.

    PubMed  CAS  Google Scholar 

  17. Fox CS, Larson MG, Hwang S-J, et al.: Cross-sectional relations of serum aldosterone and urine sodium excretion to urinary albumin excretion in a community-based sample. Kidney Int 2006, 69:2064–2069.

    Article  PubMed  CAS  Google Scholar 

  18. Nishizaka MK, Zaman MA, Green SA, et al.: Impaired endothelium-dependent flow-mediated vasodilation in hypertensive subjects with hyperaldosteronism. Circulation 2004, 109:2857–2861.

    Article  PubMed  CAS  Google Scholar 

  19. Milliez P, Girerd X, Plouin PF, et al.: Evidence for an increased rate of cardiovascular events in patients with primary aldostronism. J Am Coll Cardiol 2005, 45:1243–1248.

    Article  PubMed  CAS  Google Scholar 

  20. Conn JW: The evolution of primary aldosteronism. Harvey Lect 1968, 62:257–291.

    Google Scholar 

  21. Nishizaka MK, Zaman MA, Calhoun DA: Efficacy of low-dose spironolactone in subjects with resistant hypertension. Am J Hypertens 2003, 16:925–930.

    Article  PubMed  CAS  Google Scholar 

  22. Nishizaka MK, Pratt-Ubunama M, Zaman MA, et al.: Validity of plasma aldosterone-to-renin activity ratio in African American and white subjects with resistant hypertension. Am J Hypertens 2005, 18:805–812.

    Article  PubMed  CAS  Google Scholar 

  23. Mattsson C, Young WF Jr: Primary aldosteronism: diagnostic and treatment strategies. Nat Clin Pract Nephrol 2006, 2:198–208.

    Article  PubMed  CAS  Google Scholar 

  24. Nwariaku FE, Miller BS, Auchus R, et al.: Primary hyperaldosteronism: effect of adrenal vein sampling on surgical outcome. Arch Surg 2006, 141:497–503.

    Article  PubMed  Google Scholar 

  25. Sawka AM, Young WF, Thompson GB, et al.: Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann Intern Med 2001, 135:258–261.

    PubMed  CAS  Google Scholar 

  26. Goessens BM, Visseren FL, Olijhoek JK, et al.: Multidisciplinary vascular screening program modestly improves treatment of vascular risk factors. Cardiovasc Drugs Ther 2005, 19:429–435.

    Article  PubMed  CAS  Google Scholar 

  27. Garg JP, Elliott WJ, Folker A, et al.: Resistant hypertension revisited: a comparison of two university-based cohorts. Am J Hypertens 2005, 18:619–626.

    Article  PubMed  Google Scholar 

  28. Ventura HO, Taler SJ, Strobeck JE: Hypertension as a hemodynamic disease: the role of impedance cardiography in diagnostic, prognostic, and therapeutic decision making. Am J Hypertens 2005, 18:26–43S.

    Article  Google Scholar 

  29. Ouzan J, Perault C, Lincoff AM, et al.: The role of spironolactone in the treatment of patients with refractory hypertension. Am J Hypertens 2002, 15:333–339.

    Article  PubMed  CAS  Google Scholar 

  30. Mahmud A, Mahgoub M, Hall M, Feely J: Does aldosterone-to-renin ratio predict the antihypertensive effect of the aldosterone antagonist spironolactone? Am J Hypertens 2005, 18:1631–1635.

    Article  PubMed  CAS  Google Scholar 

  31. Lane DA, Shah S, Beevers DG: Low-dose spironolactone in the management of resistant hypertension: a surveillance study. J Hypertens 2007, 25:891–894.

    Article  PubMed  CAS  Google Scholar 

  32. Chapman N, Dobson J, Wilson S, et al.: Effect of spironolactone on blood pressure in subjects with resistant hypertension. Hypertension 2007, 49:839–845.

    Article  PubMed  CAS  Google Scholar 

  33. Flack JM, Oparil S, Pratt JH, et al.: Efficacy and tolerability of eplerenone and losartan in hypertensive black and white patients. J Am Coll Cardiol 2003, 41:1148–1155.

    Article  PubMed  CAS  Google Scholar 

  34. Saha C, Eckert GJ, Ambrosius WT, et al.: Improvement in blood pressure with inhibition of the epithelial sodium channel in blacks with hypertension. Hypertension 2005, 46:481–487.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Vascular Biology and Hypertension Program, University of Alabama at Birmingham, 933 19th Street South, Room 115, Birmingham, AL, 35294, USA

    Eduardo Pimenta

Authors
  1. Eduardo Pimenta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David A. Calhoun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eduardo Pimenta.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pimenta, E., Calhoun, D.A. Resistant hypertension and aldosteronism. Current Science Inc 9, 353–359 (2007). https://doi.org/10.1007/s11906-007-0066-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11906-007-0066-7

Keywords

Search

Navigation