Hypertensive Patients That Respond to Aldosterone Antagonists May Have a Nonclassical 11β-HSD2 Deficiency

To the Editor: Recently, Dudenbostel, and Calhoun¹ showed the benefits of aldosterone antagonists for blood pressure control in resistant hypertension patients with normal or low aldosterone levels, suggesting a mineralocorticoid-dependent mechanism, similar to patients carrying an 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) deficiency. However, another recent publication by the same group (Ghazi and Calhoun)² shows that 11β-HSD2 activity evaluated by urinary free cortisol to cortisone ratio is similar in patients with resistant hypertension compared with the control group. Nevertheless, we and others have shown that essential hypertensive patients have an increased cortisol to cortisone ratio both in urine and serum samples when compared to normotensive subjects.^3,4 In addition, we have also reported that low renin essential hypertensive patients have serum F/E ratios, which negatively correlate to serum aldosterone and plasma renin activity.³

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