Table 1

Physiologically individualised therapy* based on renin/aldosterone profile

Primary hyperaldosteronismLiddle's syndrome and variants (renal Na+ channel mutations)Renal/renovascular
Primary treatmentAldosterone antagonist (spironolactone or eplerenone)
Amiloride for men where eplerenone is not available (rarely surgery)
AmilorideAngiotensin receptor blocker or renin inhibitor§ (rarely revascularisation)
  • Reproduced by permission of Elsevier from: Spence.19

  • *It should be stressed that this approach is suitable for tailoring medical therapy in resistant hypertensives; further investigation would be required to justify adrenalectomy or renal revascularisation.

  • †Levels of plasma renin and aldosterone must be interpreted in the light of the medication the patient is taking at the time of sampling. In a patient taking an angiotensin receptor blocker (which would elevate renin and lower aldosterone), a plasma renin that is in the low normal range for that laboratory, with a plasma aldosterone in the high normal range, probably represents primary hyperaldosteronism, for the purposes of adjusting medical therapy.

  • §Angiotensin receptor antagonists are less effective because of aldosterone escape via non-ACE pathways such as chymase and cathepsin.