title: Aldosterone escape with diuretic or angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker combination therapy in patients with mild to moderate hypertension.
abstract: Renin-angiotensin-aldosterone system (RAAS) hyperactivity is implicated in the development of hypertension and progressive damage in target organs. Chronic inhibition of the RAAS or use of thiazide-type diuretics may trigger an aldoster-one escape. The aim of this study was to assess this phenomenon in hypertensive patients treated with thiazide-type diuretics (hydrochlorothiazide [HCTZ]) or single or double blockade of the RAAS (irbesartan [IRBE], quinapril [QUIN], and IRBE+QUIN). Blood pressure levels were obtained by 24-hour ambulatory blood pressure monitoring. Plasma renin activity and aldosterone levels were determined by immunoradiometric assay. Blood pressure level was normalized in the 4 treatment groups; the HCTZ and IRBE+QUIN groups showed an increased plasma aldosterone level after 12 weeks (9.1+/-2.2 to 14.1+/-1.4 and 6.9+/-1.9 to 12.9+/-2.3 ng/dL, respectively; P<.05), whereas plasma renin activity was increased only in the HCTZ group (0.9+/-0.2-1.7+/-0.2 ng/mL/h; P<.05). The increase in plasma aldosterone level after 12 weeks of HCTZ and IRBE+QUIN therapy suggests early aldosterone escape.
authors.affiliation: Laboratory of Cardiovascular Pharmacology and Hypertension, Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil. samiraug@uol.com.br
authors.forename: Samira
authors.initials: S
authors.lastname: Ubaid-Girioli
authors.forename: Sílvia Elaine
authors.initials: SE
authors.lastname: Ferreira-Melo
authors.forename: Leoní Adriana
authors.initials: LA
authors.lastname: Souza
authors.forename: Eduardo Arantes
authors.initials: EA
authors.lastname: Nogueira
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Yugar-Toledo
authors.forename: Antonio
authors.initials: A
authors.lastname: Coca
authors.forename: Heitor
authors.initials: H
authors.lastname: Moreno
mesh_terms: D000450:Aldosterone / Q000097:blood*; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001713:Biphenyl Compounds / Q000627:therapeutic use*; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006973:Hypertension / Q000097:blood / Q000188:drug therapy*; D000077405:Irbesartan; D008297:Male; D008875:Middle Aged; D000077583:Quinapril; D044005:Tetrahydroisoquinolines / Q000627:therapeutic use*; D013777:Tetrazoles / Q000627:therapeutic use*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D001713:Biphenyl Compounds; D004232:Diuretics; D044005:Tetrahydroisoquinolines; D013777:Tetrazoles; D006852:Hydrochlorothiazide; D000450:Aldosterone; D000077405:Irbesartan; D000077583:Quinapril