Article Text

  1. K. K. Gaddam,
  2. M. N. Pratt-Ubunama,
  3. M. K. Nishizaka,
  4. D. A. Calhoun
  1. Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, AL


Background We have recently reported a 20% incidence of primary aldosteronism (PA) among subjects with resistant hypertension. The reason for the high prevalence of hyperaldosteronism in this high-risk group is unknown. The current study was designed to identify potential stimuli of aldosterone secretion in subjects with resistant hypertension.

Methods Consecutive subjects referred to the University of Alabama at Birmingham (UAB) hypertension clinic for resistant hypertension (uncontrolled blood pressure on 3 antihypertensive agents) were prospectively evaluated with a plasma aldosterone concentration (PAC), plasma direct renin (PDR), a 24-hr urine collection for aldosterone, cortisol, sodium, and potassium during a normal diet. All subjects were on a stable antihypertensive regimen without use of potassium-sparing diuretics.

Results A total of 85 subjects were evaluated, including 42 males and 43 females. Age (53.9 6 11.4 vs 54.8 6 12), BMI (32.6 6 5.4 vs 32.8 6 7.5), clinic blood pressure (153 6 28/91 6 17 vs 158 6 26/85 6 15), number of antihypertensive medications (4.0 6 1.2 vs 4.3 6 1) were similar in male and female subjects. Urinary aldosterone was higher in men compared to women (13.3 6 7.4 vs 8.9 6 4.9 μg/24 hr, p = .0019). Urinary cortisol (l09.1 6 43.4 vs 71 6 45.1 μg/24 hr, p = .0002), sodium (231.5 6 115.7 vs 160.5 6 87.6 mEq/24 hr, p = .0021), and potassium (77.4 6 30.3 vs 59.9 6 24.6 mEq/24 hr, p ≤ .0001) were also higher in male subjects. Urinary aldosterone excretion was positively correlated with cortisol excretion (see the Figure).

Conclusion These data are the first to demonstrate a gender difference in aldosterone excretion in subjects with resistant hypertension. Potential stimuli of aldosterone underlying this gender difference include greater dietary ingestion of potassium by the male subjects and/or ACTH stimulation as suggested by the same gender difference in aldosterone and cortisol excretion.

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