Physiologically individualised therapy* based on renin/aldosterone profile
| Primary hyperaldosteronism | Liddle's syndrome and variants (renal Na+ channel mutations) | Renal/renovascular | |
|---|---|---|---|
| Renin | Low† | Low | High |
| Aldosterone | High† | Low | High |
| Primary treatment | Aldosterone antagonist (spironolactone or eplerenone) Amiloride for men where eplerenone is not available (rarely surgery) | Amiloride | Angiotensin 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.