Aldosterone a Relevant Factor in the Beginning and Evolution of Arterial Hypertension

<span class="paragraphSection">Data from the Framingham Heart Study have shown that increased levels of serum aldosterone predict a future increase in blood pressure (BP) and incident hypertension in nonhypertensive subjects.^{<a href="#CIT0001" class="reflinks">1</a>} In the same line, this group demonstrated that a similar predictive capacity was observed for elevated levels of plasma aldosterone–renin ratio.^{<a href="#CIT0002" class="reflinks">2</a>} These data point to the potential existence of an increased release of aldosterone that determines the future development of arterial hypertension. Two decades before these relevant data were published the group of Joel Menard in Paris demonstrated that in established hypertension treatment with spironolactone at around 100 mg od was able to significantly decrease BP levels similarly in men and women.^{<a href="#CIT0003" class="reflinks">3</a>} Probably the use of spironolactone was based on the previous demonstration that in sustained essential hypertension there is an excess of plasma aldosterone potentially related to an abnormality in the adrenal secretion of the hormone as the aldosterone excess could not be explained by changes in hepatic blood flow and/or in the metabolic clearance rate of aldosterone.^{<a href="#CIT0004" class="reflinks">4</a>} The initial positive results using a mineralocorticoid receptor antagonist in mild-to-moderate essential hypertension were forgotten but spironolactone continued to be the drug of choice in primary and secondary forms of hyperaldosteronism, to reappear in the treatment of arterial hypertension several decades later when the good effects of the administration of 25–50 mg of the drug in resistant hypertension were demonstrated.^{<a href="#CIT0005" class="reflinks">5</a>} Also recent data have shown the positive effects of eplerenone in mild-to-moderate hypertension, particularly if accompanied by low renin levels.^{<a href="#CIT0006" class="reflinks">6</a>}</span>

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