Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2018 Aug;93(8):980-990.
doi: 10.1016/j.mayocp.2018.05.027.

Aldosterone, Hypertension, and Antihypertensive Therapy: Insights From a General Population

Valentina Cannone  1 , Alessia Buglioni  2 , S Jeson Sangaralingham  2 , Christopher Scott  3 , Kent R Bailey  3 , Richard Rodeheffer  4 , Margaret M Redfield  5 , Riccardo Sarzani  6 , John C Burnett Jr  2
Affiliations
Comparative Study

Aldosterone, Hypertension, and Antihypertensive Therapy: Insights From a General Population

Valentina Cannone et al. Mayo Clin Proc. 2018 Aug.

Abstract

Objective: To investigate the relationships among aldosterone level, use of antihypertensive (anti-HTN) medications, clinical profile, and atrial natriuretic peptide (ANP) level in individuals with HTN.

Participants and methods: In a community-based cohort, we analyzed aldosterone plasma levels based on the presence (n=477) or absence (n=1073) of HTN. In individuals with HTN, we evaluated circulating aldosterone levels according to the number of anti-HTN drugs used, analyzed the associated clinical characteristics, and determined the relationship to the counterregulatory cardiac hormone ANP. Data were collected from August 25, 1997, through September 5, 2000.

Results: Participants with HTN had higher serum aldosterone levels than those without HTN (6.4 vs 4.1 ng/dL [to convert to pmol/L, multiply by 27.74]; P<.001). When individuals with HTN were stratified according to the number of anti-HTN medications used, the increase in number of medications (0, 1, 2, and ≥3) was associated with higher aldosterone levels (4.8, 6.4, 7.10, and 7.9 ng/dL, respectively; P=.002), worse metabolic profile, and higher prevalence of cardiovascular, renal, and metabolic disease. In participants with HTN, ANP plasma levels were inversely related to aldosterone levels when the latter was divided into tertiles.

Conclusion: In this randomly selected general population cohort, aldosterone levels were higher in individuals with HTN compared with normotensive participants. Aldosterone levels increased with anti-HTN medication use. These findings also suggest a relative ANP deficiency with increasing aldosterone levels and anti-HTN drug use. These studies have pathophysiologic and therapeutic implications for targeting aldosterone in the clinical treatment of HTN.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
Plasma aldosterone levels in subjects with hypertension stratified by number of anti-hypertensive drugs taken. Median (line in box), Q1 (lower box), Q3 (upper box) and mean (diamond). The whiskers extend to 1.5×IQR above and below the box (or the max or min values if there are no points outside of 1.5×IQR from the box). The circles are subjects that are above 1.5× IQR. Unadjusted P< .001. Anti-HTN= anti-hypertensive.
Figure 2:
Figure 2:
Inverse relationship between plasma aldosterone and atrial natriuretic peptide in hypertensive subjects. Aldosterone analyzed by tertiles and atrial natriuretic peptide as continuous variable (mean and 95% CI). Age-gender-BMI-MI-heart failure-atrial fibrillation-GFR adjusted P = .007. ANP= atrial natriuretic peptide
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

References

    1. Brilla CG, Weber KT. Mineralocorticoid excess, dietary sodium, and myocardial fibrosis. J Lab Clin Med. 1992. December;120(6):893–901. - PubMed
    1. Calhoun DA. Aldosterone and cardiovascular disease: smoke and fire. Circulation. 2006. December 12;114(24):2572–2574. - PubMed
    1. Dudenbostel T, Ghazi L, Liu M, et al. Body mass index predicts 24-hour urinary aldosterone levels in patients with resistant hypertension. Hypertension. 2016. October;68(4):995–1003. - PMC - PubMed
    1. Gaddam K, Corros C, Pimenta E, et al. Rapid reversal of left ventricular hypertrophy and intracardiac volume overload in patients with resistant hypertension and hyperaldosteronism: a prospective clinical study. Hypertension. 2010. May;55(5):1137–1142. - PMC - PubMed
    1. Williams B, MacDonald TM, Morant S, et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomized, double-blind, crossover trial. Lancet. 2015. November 21;386(10008):2059–2068. - PMC - PubMed

Publication types

MeSH terms