The mechanisms of aldosteronism

In this study, researchers evaluated the contributions of renin-independent and ACTH-mediated aldosteronism in patients with a low-renin phenotype. The study included 348 patients with different blood pressure profiles: severe and/or resistant hypertension, hypertension with hypokalemia, high blood pressure and stage I/II hypertension, or normal blood pressure.  Analyses revealed a continuum of non-suppressible, renin-independent aldosterone production after a saline suppression test. This continuum corresponded to the different blood pressure situations encountered in the patients. In parallel, there was a continuum of ACTH-mediated aldosteronism. Some patients met the criteria for adrenalectomy, others for treatment with mineralocorticoid receptor antagonists.