title: Menopause not aldosterone-to-renin ratio predicts blood pressure response to a mineralocorticoid receptor antagonist in primary care hypertensive patients.
abstract: BACKGROUND
  It has been suggested that hypertensive patients with raised aldosterone-to-renin ratio (ARR) are specifically sensitive to mineralocorticoid receptor antagonists (MRAs). We have previously shown that patients with an elevated ARR are relatively frequent in the setting of primary care. We therefore designed an interventional study to ascertain whether primary care hypertensive patients with an elevated ARR presented a superior response to MRA treatment than subjects with normal ratio.
  
  
  METHODS
  According to the previously observed distribution in general population, 1/3 and 2/3 of hypertensive patients with high or normal ARR, respectively, were treated with kanrenoate 50-100 mg/day for 2 months. To avoid uncontrolled blood pressure (BP), 49% of patients continued also "ARR-neutral" drugs such as verapamil and/or alpha-adrenergic blockers. Patients groups were matched for most features but an elevated ARR was more frequent in female than in male gender; moreover, 90% of women with raised ARR were in menopause.
  
  
  RESULTS
  A clear reduction of BP values was recorded after both the first and the second month of treatment with kanrenoate, with the maximal effect obtained when the dosage titration at 100 mg/day was accomplished. However, patients previously identified by a raised ARR did not have a larger response to MRA treatment than patients with normal ratio. In contrast, MRA was twofold more effective in reducing SBP in women than in men (after 2 months of treatment -16.4 mm Hg vs.-8.2 mm Hg).
  
  
  CONCLUSIONS
  These results suggest that postmenopausal hypertension is largely dependent on mineralocorticoid receptor activation and selectively sensitive to MRAs.
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University of Verona, Verona, Italy. oliviero.olivieri@univr.it
authors.forename: Oliviero
authors.initials: O
authors.lastname: Olivieri
authors.forename: Francesca
authors.initials: F
authors.lastname: Pizzolo
authors.forename: Alberto
authors.initials: A
authors.lastname: Ciacciarelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Corrocher
authors.forename: Denise
authors.initials: D
authors.lastname: Signorelli
authors.forename: Salvatore
authors.initials: S
authors.lastname: Falcone
authors.forename: Gian S
authors.initials: GS
authors.lastname: Blengio
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000494:pharmacology; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D001794:Blood Pressure / Q000187:drug effects*; D002191:Canrenoic Acid / Q000494:pharmacology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists; D018161:Receptors, Mineralocorticoid / Q000502:physiology; D012083:Renin / Q000097:blood*; D014700:Verapamil / Q000494:pharmacology
chemical_list: D000317:Adrenergic alpha-Antagonists; D000451:Mineralocorticoid Receptor Antagonists; D018161:Receptors, Mineralocorticoid; D000450:Aldosterone; D002191:Canrenoic Acid; D014700:Verapamil; D012083:Renin