Treating high blood pressure or heart failure very often calls for using a diuretic or fluid pill. When we use a diuretic, we increase the levels of the disease producing factors angiotensin II and aldosterone very predictably. That causes a secondary hyperaldosteronism. That produces low potassium levels along with arterial and organ damage while increasing the blood pressure. This is an everyday occurence in primary care practices but we are not behaving as if that is a fact.
We do regularly give medications like lisinopril or losartan that block angiotensin II and lower the blood pressure while increasing the potassium, but we do not give spironolactone or eplerenone to address the increase in aldosterone that is equally predictable. Losartan and lisinopril do lower the aldosterone level, but it is not enough. Small doses of spironolactone or eplerenone—start with12.5 mg every day or every other day—block the effects of aldosterone and increase potassium levels while also promoting salt and water losses.
That can be very beneficial in the metabolic syndrome and in terms of organ protection. Doses of spironolactone over 25 mg. may cause breast enlargement in men. Eplerenone avoids that problem. Combining diuretics, losartan or lisinoprile, and spironolactone or eplerenone in treating heart failure and hypertension does not merely lower the blood pressure or reduce symptoms. It interferes with the biology that causes high blood pressure, heart failure, heart attack, stroke, and chronic kidney disease. It is precision medicine. Low doses of medication that block aldosterone effects are safe, but it is important to monitor potassium and kidney function closely when starting these medications or increasing doses. One of the best things you can do for your patients with hypertension or heart failure is to appropriately block the effects of increased aldosterone.
Agreed. However, if we all focus on early signs of trouble caused by poor lifestyle and eating habits choices in younger people, all this could be completely avoided.