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Published Online, 19 December 2006, www.theannals.com, DOI 10.1345/aph.1H456.
 The Annals of Pharmacotherapy: Vol. 41, No. 1, pp. 129-132. DOI 10.1345/aph.1H456
© 2007 Harvey Whitney Books Company.
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Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Hypertension Due to Primary Aldosteronism: A Case for Exclusion

Carolyn D Bubbar, BSP PharmD

at time of study, PharmD Student, College of Pharmacy, University of Toronto, Toronto, Ontario, Canada

David F Blackburn, PharmD

Assistant Professor, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Merne P Wilson, BScN MSc

Coordinator, Ambulatory Hypertension Clinic, Royal University Hospital, Saskatoon

Thomas W Wilson, MD FRCPC

Professor and Head, College of Medicine, University of Saskatchewan

Reprints: Dr. Blackburn, College of Pharmacy and Nutrition, University of Saskatchewan, 110 Science Pl., Saskatoon, SK S7N 5C9, Canada, fax 306/966-6377, d.blackburn{at}usask.ca

Aldosterone antagonists are the mainstay of therapy in patients with hypertension due to primary aldosteronism. However, in our experience, these patients are sometimes placed on angiotensin-converting enzyme (ACE) inhibitors in accordance with guidelines applying to the general hypertensive population. We believe this practice is inappropriate because of the inability of ACE inhibitors to lower blood pressure in patients with low renin levels. Furthermore, pleiotropic effects of ACE inhibitors are unlikely to provide significant benefits in the absence of blood pressure reduction. Therefore, ACE inhibitors should be discouraged for the majority of patients with primary aldosteronism, even in the face of renal or cardiac disease.

Key Words: aldosteronism, angiotensin-converting enzyme inhibitors, hypertension

Published Online, December 19, 2006. www.theannals.com, DOI 10.1345/aph.1H456




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