Essential Hypertension In Patients With Aldosterone Escape Phenomenon With Left Ventricular Hypertrophy

ObjectiverTo investigate aldosterone escape during angiotensin-converting enzyme inhibitor(ACEI) therapy in essential hypertensive(EH) patients and its relationship with left ventricular hypertrophy, observe the effects of aldosterone antagonist- spironlactone combined with ACEI on aldosterone escape and left ventricular hypertrophy.Methods: EH patients were divided into left ventricular hypertrophy(LVH) group and non- left ventricular hypertrophy(NLVH) group by the results of echocardiographic measurement, all patients were treated with ACEI -enalapril.Plasma angiotensin II(Angll) and aldosterone(Ald) concentrations were measured by commercial radioimmunoassay,left ventricular mass index(LVMI) were calculated by echocardiograph before and after 1 . 3 . 6 months treatment respectively. Aldosterone escape was estimated by the plasma Aid levels after 3 months treatment, spironlactone was given to those patients with aldosterone escape,and the effects were observed.ResultstAfter 1 month enalapril treatment,both the plasma Angll and Aid concentrations of the patients decreased compared with before treatment.But after 3 months treatment,the the plasma Angll levels increased slightly,the plasma Aid levels increased significantly. Aldosterone escape was observed in 28 of 65 patients after 3 months enalapril treatment,the incidence of aldosterone escape was 43%.Before treatment the plasma Aid level of LVH group was higher than that of NLVH group,there was a positive correlation between the plasma Aid level and LVMI.After 3 months treatment,in the LVH group,LVMI did not change in patients with aldosterone escape but decreased significantly in patients without aldosteron escape. After treated with spironlactone for 3 months, the plasma Angll and Aid concentrations of 28 patients with aldosterone escape decreased,but no significance,and the LVMI of 16 patients with aldosterone escape in LVH group decreased, but no significance either.Conclusion: Aldosterone escape may occur during continuous(>3 months) ACEI therapy in some of EH patients. There is relationship between the plasmaAid level and LVH in EH patients. Aldosterone escape may reverse the beneficial effects of ACEI on LVH. Aldosterone antagonist- spironlactone combined with ACEI may be useful to aldosterone escape in EH patients.