The Syndrome of Essential Hypertension and Suppressed Plasma Renin Activity

Because amino-glutethimide, an inhibitor of steroid synthesis, lowers the blood pressure of patients with essential hypertension and suppressed renin activity, the present double-blind study was designed to assess the effect of the mineralocorticoid antagonist, spironolactone, on blood pressure in such patients. Twenty-three of 24 patients with suppressed renin activity responded to spironolactone, 400 mg/day for six weeks. Average decrease in mean blood pressure was 20 mm Hg. There was no response to placebo. A control group of 18 patients with essential hypertension and normal renin activity showed no significant change in blood pressure in response to spironolactone or placebo. Fourteen spironolactone-responsive patients were normotensive when maintained on doses of 100 to 200 mg/day. This study supports the concept that the syndrome of essential hypertension with suppressed renin activity is related to mineralocorticoid secretion.