Treatment-resistant hypertension caused by hormone imbalance

Researchers have discovered resistant hypertension may often result from salt retention due to a steroid hormone imbalance.

In the study, which could change clinical practice, a London-based team of researchers found that a steroid hormone - aldosterone - causes salt to accumulate in the bloodstream causing a rise in blood pressure and making hypertension difficult to treat. These patients are described as having resistant hypertension where blood pressure remains uncontrolled despite treatments.

The new results come from a six year trial (PATHWAY2), which assessed 314 patients with resistant hypertension. In two patients, a benign aldosterone-producing nodule was found in one of their adrenal glands. Removing the nodules allowed the patients to come off all drugs.

The researchers believe that many more patients may have this untreated pathology.  

First author of the paper Professor Bryan Williams, NIHR University College London Hospitals BRC Director and Director of Research at UCLH, said: “These results are important because they will change clinical practice across the world and will help improve the blood pressure and outcomes of our patients with resistant hypertension.”

In previous work, Professor Bryan Williams and colleagues demonstrated that a 50-year old drug, spironolactone, can be repurposed to treat resistant hypertension. Spironolactone is a steroid blocker of aldosterone, which has the ability to overcome salt excess seen in patients. The accumulation of salt is caused by the failure of the kidneys to excrete dietary salt through the kidneys.

Professor Bryan Williams said: “It is remarkable when so many advances in medicine depend on expensive innovation, that we have been able to revisit the use of drugs developed over half a century ago and show that for this difficult-to-treat population of patients, they work really well.”

Hypertension is one of the most preventable causes of heart attack, heart failure, stroke and premature death. High blood pressure affects over 1 billion people across the world and accounts for 10 million potentially avoidable deaths a year.

To read the full paper visit The Lancet.

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