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Importance of dietary salt restriction for patients with primary aldosteronism during treatment with mineralocorticoid receptor antagonists: The potential importance of post-treatment plasma renin levels

Hypertension Research volume 46, pages 100–107 (2023)Cite this article

Abstract

We measured dietary salt intake in 26 patients with primary aldosteronism treated with mineralocorticoid receptor antagonists and evaluated whether plasma renin levels were affected by dietary salt intake pre-treatment and post 6 months of mineralocorticoid receptor antagonist treatment. The dietary salt intake level was calculated using spot urine sodium and creatinine concentrations, body weight, height, and age. The clinical parameters pre- and post- treatment were compared. The systolic and diastolic blood pressure levels decreased, and the serum potassium and active renin concentration increased significantly. Although the dietary salt intake did not change after treatment, the differences in dietary salt intake and active renin concentration pre- and post- treatment were inversely correlated (r = –0.418, p = 0.03). The 26 patients were divided into two groups with active renin concentration levels ≥5 pg/mL (Group 1) and <5 pg/mL (Group 2) after treatment. The Group parameters did not differ pre- and post- treatment. Group 1 evidenced improvements in systolic and diastolic blood pressures, and the potassium level and active renin concentration over time; Group 2 did not. Group 1 evidenced no significant correlation between the differences in dietary salt intake and active renin concentration levels (r = –0.481, p = 0.11) but Group 2 showed a strong inverse correlation (r = –0.7599, p = 0.01). In conclusion, we found that an active renin concentration level <5 pg/mL post-mineralocorticoid receptor antagonist treatment may indicate that salt sensitivity has not adequately improved, emphasizing the importance of measuring plasma renin levels after such treatment.

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Fig. 1: Overview.
Fig. 2: Correlations between the ΔeNaCl and the ΔARC before and after MRA treatment.

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Acknowledgements

We thank the physicians and medical staff of the Department of Endocrinology and Diabetology, Oita University Hospital, who treated the patients who participated in this study.

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Authors and Affiliations

  1. Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu, Japan

    Yuichi Yoshida, Mizuki Kinoshita, Kentaro Sada, Shotaro Miyamoto, Yoshinori Ozeki, Yumi Mori, Naoki Matsuda, Takaaki Noguchi, Hiroshi Nakama, Mitsuhiro Okamoto, Koro Gotoh, Takayuki Masaki & Hirotaka Shibata

  2. Faculty of Medicine, Oita University, Yufu, Japan

    Rika Fujiki

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Correspondence to Hirotaka Shibata.

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HS has honorarium from Daiichi-Sankyo Company, Mochida Pharmaceuticals, Astrazeneca, Novartis Pharma, Bayer, and Astellas. HS also received scholarship from Chugai and Bayer.

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Yoshida, Y., Fujiki, R., Kinoshita, M. et al. Importance of dietary salt restriction for patients with primary aldosteronism during treatment with mineralocorticoid receptor antagonists: The potential importance of post-treatment plasma renin levels. Hypertens Res 46, 100–107 (2023). https://doi.org/10.1038/s41440-022-01045-5

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