Aldosterone-receptor antagonism in hypertension.
The role of the renin-angiotensin-aldosterone system (RAAS) in hypertension has since long been recognized and aldosterone has been acknowledged as one of the key hormones in the pathophysiology, not only in primary aldosteronism but also in essential hypertension and drug-resistant hypertension. Aldosterone-receptor antagonists (ARAs) are increasingly used in patients with resistant hypertension, often with impressive results. However, definitive evidence for the benefit of ARAs in these patients from randomized, controlled trials is lacking. This review gives an overview of the current data on this topic. Future studies should focus on the identification of factors that are able to predict the response to treatment, as to select patients who will benefit most from treatment with ARAs. On the basis of the current knowledge, we recommend prescription of ARAs to patients with primary aldosteronism, resistant hypertension and patients with hypertension and hypokalemia.
Jansen
Pieter M
PM
Division of Pharmacology, Vascular and Metabolic Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
Danser
A H Jan
AH
Imholz
Ben P
BP
van den Meiracker
Anton H
AH
D000419:Albuminuria / Q000209:etiology; D000450:Aldosterone / Q000502:physiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000818:Animals; D001145:Arrhythmias, Cardiac / Q000209:etiology; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D000077545:Eplerenone; D005355:Fibrosis; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy; D000451:Mineralocorticoid Receptor Antagonists; D009206:Myocardium / Q000473:pathology; D013148:Spironolactone / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000450:Aldosterone; D000077545:Eplerenone