Effect of an adrenal inhibitor in hypertensive patients with suppressed renin

Patients with essential hypertension can be divided into subpopulations according to their plasma renin values. Approximately 80% have normal or near-normal plasma renin values while 20% have distinctly subnormal renin values in response to the double stimuli of upright posture and sodium depletion. In the present study, nine patients with suppressed renin activity were compared with five patients with normal renin values in search of other physiologic differences that might shed light on the pathophysiology of the hypertensive state. Hypertensive patients with suppressed renin activity differed from those with nonsuppressed renin activity in two respects: They had significantly higher exchangeable sodium values, and they responded to the adrenal inhibitor, aminoglutethimide, with significant decreases in blood pressure. From the results of this study one might infer either that some unidentified mineralocorticoid is present in excessive quantities in the patients with suppressed plasma renin activity or that even normal levels of aldosterone