Aldosterone Antagonists in Diuretic Therapy

Abstract

Since 1955, when the clinical picture of aldosteronism was first described, the substance aldosterone has aroused the interest of the physiologist, pharmacologist, renologist, and clinician.¹Conditions associated with increased aldosterone activity can be divided into two broad groups (primary and secondary) depending on whether their cause is intrinsic or extrinsic to the adrenal cortex.²Adrenal tumor, adrenal hyperplasia, and "congenital" hyperaldosteronism are examples of the primary forms. Conditions in which aldosteronism is secondary to another disease state include malignant hypertension,³renovascular hypertension,³refractory heart failure,⁴nephrotic syndrome,⁵and cirrhosis with ascites.⁶ Clinical and experimental observations have demonstrated that after initial fluid depletion induced by the administration of a diuretic agent, an antidiuretic phase frequently ensues.⁷The mechanisms underlying the loss of responsiveness and the antidiuretic phase are not precisely defined, but aldosteronism is probably an important factor. Other studies have shown that salt restriction in both normal and edematous patients