The pharmacological treatment of primary aldosteronism.
Aldosterone is increasingly considered to have a fundamental role in the pathophysiology of cardiovascular disease. Primary aldosteronism is a much more common cause of secondary hypertension than once suspected, accounting for approximately 10% of cases. Screening for primary aldosteronism should be considered even in the presence of normokalaemia. The non-classical effects of aldosterone, some of which are transcription-independent, may be of similar or greater importance than its traditional effects on the kidney. Treatment of primary aldosteronism should be specific and aim to ameliorate all hormone-related effects of aldosterone, not just the most obvious manifestation of hypertension. Mineralocorticoid antagonism, shown to lead to significant additional survival advantage in heart failure, offers the best prospect for achieving therapeutic goals. For the increasing proportion of patients with primary aldosteronism suitable for long-term medical treatment, mineralocorticoid receptor blockade (better tolerated with eplerenone) should be considered the most appropriate choice of treatment, pending the development of better alternatives.
Department of Endocrinology, Royal Free Hospital, London, NW3 2QG, UK.
Salim
S
Janmohamed
Pierre-Marc G
PM
Bouloux
D000450:Aldosterone / Q000378:metabolism; D000584:Amiloride / Q000494:pharmacology / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D006973:Hypertension / Q000209:etiology / Q000517:prevention & control; D000451:Mineralocorticoid Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D018161:Receptors, Mineralocorticoid / Q000378:metabolism; D026941:Sodium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use; D013148:Spironolactone / Q000494:pharmacology / Q000627:therapeutic use
D002121:Calcium Channel Blockers; D005938:Glucocorticoids; D000451:Mineralocorticoid Receptor Antagonists; D018161:Receptors, Mineralocorticoid; D026941:Sodium Channel Blockers; D013148:Spironolactone; D000450:Aldosterone; D000584:Amiloride