Plasma aldosterone concentration in the patient with diabetes mellitus.
BACKGROUND
Vascular injury at the microvascular and macrovascular levels plays a crucial role in the patient with diabetes mellitus. Evidence for renin-system activation in many patients with type 1 diabetes mellitus has raised the possibility that aldosterone-widely recognized as a contributor to vascular injury-could play a role.


METHODS
We examined the state of the renin-angiotensin-aldosterone system (RAAS) in 58 subjects with type 1 diabetes mellitus and 64 age-matched normal control subjects. All studies were performed on a fixed sodium (200 mmol/day) and potassium (100 mmol/day intake), and samples were drawn at 8:00 a.m. to avoid the influence of circadian rhythms.


RESULTS
The patient with diabetes mellitus showed an increase in plasma renin activity (PRA) (P < 0.01), plasma angiotensin II concentration (P < 0.01), and plasma aldosterone concentration (P < 0.001). A striking influence of the angiotensin receptor blocker, candesartan, on plasma aldosterone concentration in the patients with diabetes mellitus suggested strongly that renin-system activation is responsible for the elevated plasma aldosterone concentration.


CONCLUSIONS
Pharmacologic interruption of the effects of aldosterone at the tissue level could be especially useful in patients with diabetes mellitus. The dose of agents that block the renin-angiotensin system (RAS) should be adjusted to maximize the fall in plasma aldosterone concentration.
Hollenberg
Norman K
NK
Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA. djpagecapo@rics.bwh.harvard.edu
Stevanovic
Radomir
R
Agarwal
Anupam
A
Lansang
M Cecilia
MC
Price
Deborah A
DA
Laffel
Lori M B
LM
Williams
Gordon H
GH
Fisher
Naomi D L
ND
D000293:Adolescent; D000328:Adult; D000450:Aldosterone / Q000097:blood*; D000804:Angiotensin II / Q000097:blood; D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles / Q000627:therapeutic use; D001713:Biphenyl Compounds; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D012083:Renin / Q000097:blood; D013777:Tetrazoles / Q000627:therapeutic use
D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; D000804:Angiotensin II; D000450:Aldosterone; D012083:Renin; C081643:candesartan