Overlapping Spironolactone Dosing in Primary Aldosteronism and Resistant Essential Hypertension

  title={Overlapping Spironolactone Dosing in Primary Aldosteronism and Resistant Essential Hypertension},
  author={Joel F. Handler},
  journal={The Journal of Clinical Hypertension},
  • J. Handler
  • Published 1 October 2012
  • Medicine
  • The Journal of Clinical Hypertension
A 65-year-old man presented to our hypertension clinic with refractory hypertension and hypokalemia. At age 11 he was beaten up, suffering a left renal injury that required hospitalization. Subsequent diastolic blood pressures (BPs) rose to 105 mm Hg throughout high school and into college, gradually resolving off of medication. He had been treated with antihypertensive therapy for more than 25 years with poor control. Amlodipine and nifedipine were not tolerated due to edema. Hypokalemia was… 
Management of hypertension in primary aldosteronism.
Although numerous independent predictors of resolution of hypertension after adrenalectomy for unilateral adenomas have been described, the Aldosteronoma Resolution Score is a validated multifactorial model convenient for use in daily clinical practice.
The possibility of resistant hypertension during the treatment of hypertensive patients
It is recommended to consider the possibility of RH during the treatment of hypertensive patients who do not achieve appropriate blood pressure control, in order to avoid the early onset of fatal cardiovascular events and reduce medical costs.
Primary Aldosteronism: Diagnosis and Management
Assessment and management of resistant hypertension
Resistant hypertension is defined as a blood pressure level above target despite treatment with three optimally dosed, best-tolerated antihypertensive drugs of different classes.[1][1] Of the three
Hyperaldosteronism from a large adrenal adenoma in a patient with bilateral adrenal nodules
Primary aldosteronism (PA) is a potentially reversible cause of uncontrolled hypertension. Early diagnosis and timely management of PA can prevent end‐organ damage. Aldosteronoma Resolution Score
Commentary in Support of a Highly Effective Hypertension Treatment Algorithm
  • J. Handler
  • Medicine
    Journal of clinical hypertension
  • 2013
A simple hypertension treatment algorithm built on the fixed‐dose combination drug lisinopril/hydrochlorothiazide, which is maximized in three steps before adding amlodipine, is the preferred fourth drug.


Efficacy of low-dose spironolactone in subjects with resistant hypertension.
Effect of Spironolactone on Blood Pressure in Subjects With Resistant Hypertension
Evaluated among 1411 participants in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm, the use of spironolactone in uncontrolled hypertension effectively lowers blood pressure in patients with hypertension uncontrolled by a mean of ≈3 other drugs is supported.
Spironolactone versus eplerenone for the treatment of idiopathic hyperaldosteronism
It was concluded that eplerenone was as effective as spironolactone in reducing BP in patients with IHA and the risk of mild hyperkalaemia was similar with both drugs.
Primary Aldosteronism: Diagnosis and Treatment
A reasonable treatment strategy is to attempt medical therapy in all patients with a high plasma aldosterone/PRA ratio and reserve the extensive workup needed to identify an APA for those patients whose hypertension or hypokalemia cannot be controlled medically.
Studies of Impaired Aldosterone Response to Spironolactone‐Induced Renin and Potassium Elevations in Adenomatous but Not Hyperplastic Primary Aldosteronism
Spironolactone treatment causes a sustained impairment of the aldosterone secretory response to normalized PRC and K, but not to ACTH stimulation, only in patients with APA.
Medical Management of Aldosterone-Producing Adenomas
The efficacy of medical management for aldosterone-producing adenomas with regard to blood pressure and serum electrolytes is demonstrated and the morbidity associated with choosing medical over surgical management is discussed.
Factors influencing outcome of surgery for primary aldosteronism.
The study showed that the main determinants of a surgical cure of hypertension in primary aldosteronism were presence of adenoma and preoperative response to spironolactone.
Treatment of primary aldosteronism.
  • M. Quinkler, P. Stewart
  • Medicine, Biology
    Best practice & research. Clinical endocrinology & metabolism
  • 2010
Comparison of Surgery and Prolonged Spironolactone Therapy in Patients with Hypertension, Aldosterone Excess, and Low Plasma Renin
Spironolactone can now be advised as long-term therapy in selected patients with hypertension, aldosterone excess, and low plasma renin, with no evidence of escape from control during therapy lasting several years in some cases.