Spontaneous Resolution of Idiopathic Aldosteronism After Long-Term Treatment With Potassium Canrenoate
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To the Editor:
Primary aldosteronism (PA) is the most common form of secondary hypertension. The prevalence of PA is raised from 1% to 3% to 10% to 15% because of the introduction of the upright plasma aldosterone/plasma renin activity ratio (APR) as screening procedure.1 The pathogenesis of idiopathic PA (IPA), which accounts for 50% of the cases of PA, is still not clear, and several factors have been involved, such as hypersensitivity to angiotensin II or to other stimulating factors or aberrant receptors in the glomerulosa. IPA is usually treated with aldosterone receptor blockers, such as spironolactone, potassium canrenoate (KC), canrenone, or eplerenone, which have, respectively, a high (spironolactone), low (KC and canrenone), or quite absent (eplerenone) antiandrogen activity. The dose of these drugs can be progressively reduced to the lowest amount able to keep normal both blood pressure (BP) and serum potassium. In a previous study,2 we reevaluated 15 patients with IPA 1 month after withdrawal of therapy with KC after 3 to 24 years of treatment. One month after withdrawal, APR was increased only …