Hyperaldosteronism Medication

Aldosterone antagonists are indicated for the treatment of hyperaldosteronism. Hypokalemia and hypertension are also addressed with medications as needed.

Class Summary

Aldosterone antagonists are used to lower the blood pressure, normalize serum potassium, and minimize postoperative hypoaldosteronism.

Spironolactone (Aldactone)

Spironolactone is the agent most commonly used to treat hyperaldosteronism because it directly antagonizes aldosterone effects at the distal tubule.

Class Summary

Management of hypokalemia associated with hyperaldosteronism when spironolactone is contraindicated.

Triamterene (Dyrenium)

Triamterene inhibits reabsorption of sodium ions in exchange for potassium and hydrogen ions at the segment of the distal tubule that is under the control of adrenal mineralocorticoids (especially aldosterone). This activity is not directly related to aldosterone secretion or antagonism, and it is a result of a direct effect on the renal tubule.

The fraction of filtered sodium reaching this distal tubular exchange site is relatively small, and the amount that is exchanged depends on the level of mineralocorticoid activity; thus, the degree of natriuresis and diuresis produced by inhibition of the exchange mechanism is necessarily limited.

Increasing the amount of available sodium and the level of mineralocorticoid activity by using more proximally acting diuretics increases the degree of diuresis and potassium conservation. Triamterene may occasionally cause increases in serum potassium, which can result in hyperkalemia. It does not produce alkalosis, because it does not cause excessive excretion of titratable acid and ammonium.

Amiloride

Amiloride is an antikaliuretic drug with weak natriuretic, diuretic, and antihypertensive activity. It decreases the enhanced urinary excretion of magnesium that occurs when a thiazide or loop diuretic is used alone. It exerts a potassium-conserving effect in patients receiving kaliuretic diuretic agents.

Class Summary

Treatment of hypertension should be designed to lower blood pressure and reduce other risk factors of coronary heart disease. Pharmacologic therapy should be individualized on the basis of the patient’s age, race, known pathophysiologic variables, and concurrent conditions. Treatment should be aimed not only at lowering blood pressure safely and effectively but also at preventing or reversing hyperlipidemia, glucose intolerance, and left ventricular hypertrophy.

Nifedipine (Adalat, Procardia XL, Nifedical XL, Nifediac CC)

Nifedipine is a calcium channel blocker that produces vasodilation with antianginal and antihypertensive effects. It is available in both short-acting and sustained-release preparations.

Nifedipine acts by blocking postexcitation release of calcium ions into cardiac and vascular smooth muscle, thereby inhibiting the activation of adenosine triphosphatase (ATPase) on myofibril contraction. The overall effect is reduced intracellular calcium levels in cardiac and smooth muscle cells of the coronary and peripheral vasculature, resulting in dilatation of coronary and peripheral arteries.

Amlodipine (Norvasc)

Amlodipine is a calcium channel blocker that produces vasodilation with antianginal and antihypertensive effects. It acts by blocking the postexcitation release of calcium ions into cardiac and vascular smooth muscle, thereby inhibiting the activation of ATPase on myofibril contraction. The overall effect is reduced intracellular calcium levels in cardiac and smooth muscle cells of the coronary and peripheral vasculature, resulting in dilatation of coronary and peripheral arteries.

Diltiazem (Cardizem, Cardizem CD, Dilacor XR, Tiazac)

During depolarization, diltiazem inhibits calcium ions from entering the slow channels and voltage-sensitive areas of vascular smooth muscle and myocardium. It is a nondihydropyridine appropriate for prophylaxis of variant angina.

Nicardipine (Cardene)

Nicardipine relaxes coronary smooth muscle and produces coronary vasodilation, which, in turn, improves myocardial oxygen delivery and reduces myocardial oxygen consumption.

Verapamil (Calan, Calan SR, Covera HS, Isoptin, Verelan)

Verapamil is a nondihydropyridine that is appropriate for prophylaxis of variant angina. During depolarization, verapamil inhibits the entry of calcium ions into slow channels or voltage-sensitive areas of the vascular smooth muscle and myocardium.

Doxazosin (Cardura, Cardura XL)

Doxazosin is an alpha1-adrenergic antagonist, which causes vasodilation of veins and arterioles. These effects result in decreased peripheral resistance and blood pressure.

Prazosin (Minipress)

Prazosin is a postsynaptic alpha1-adrenergic antagonist. It causes vasodilation of veins and arterioles. These effects result in decreased peripheral resistance and blood pressure.