Hypertension affects about 10 - 25% of the population and is an important risk factor for cardiovascular and renal disease. The renin-angiotensin system is frequently implicated in the pathophysiology of
hypertension, be it primary or secondary. The prevalence of primary
aldosteronism increases with the severity of
hypertension, from 2% in patients with grade 1
hypertension to 20% among resistant hypertensives. Mineralcorticoid
hypertension includes a spectrum of disorders ranging from
renin-producing pathologies (
renin-secreting
tumors,
malignant hypertension,
coarctation of aorta),
aldosterone-producing pathologies (primary
aldosteronism -
Conns syndrome,
familial hyperaldosteronism 1, 2, and 3), non-
aldosterone mineralocorticoid producing pathologies (
apparent mineralocorticoid excess syndrome,
Liddle syndrome,
deoxycorticosterone-secreting
tumors, ectopic adrenocorticotropic
hormones (
ACTH) syndrome, congenitalvadrenal
hyperplasia), and drugs with mineraocorticoid activity (locorice, carbenoxole
therapy) to
glucocorticoid receptor resistance syndromes. Clinical presentation includes
hypertension with varying severity,
hypokalemia, and
alkalosis. Ratio of plasma
aldosterone concentraion to plasma
renin activity remains the best screening tool. Bilateral adrenal venous sampling is the best diagnostic test coupled with a CT scan. Treatment is either surgical (adrenelectomy) for unilateral adrenal disease versus medical
therapy for idiopathic, ambiguous, or bilateral disease. Medical
therapy focuses on blood pressure control and correction of
hypokalemia using a combination of
anti-hypertensives (
calcium channel blockers,
angiotensin converting enzyme inhibitors, or
angiotensin receptor blockers) and
potassium-raising
therapies (mineralcorticoid receptor antagonist or
potassium sparing diuretics). Direct
aldosterone synthetase antagonists represent a promising future
therapy.