PS-R05-9: A CASE IN WHICH A MINERALOCORTICOID RECEPTOR ANTAGONIST COULD IMPROVE ARB-RESISTANT PROTEINURIA IN NON-DIABETIC HYPERTENSION

Abstract

The patient is a 53-year-old man with hyperetension, obesity (Body mass index 32–34), dyslipidemia and hyperuricemia, without diabetes mellitus, who has been received antihypertensive agents since age 40. At his initial visit to our hospital at age 40, he exhibited severe hypertension of 244/163 mmHg and proteinuria of about 1000 mg/gram creatinine. According to medical interview, he had been pointed out hypertension since age 32, but denied antihypertensive therapy. Accelerated cardiac and renal damage was not shown. In addition, secondary hypertension such as renovascular hypertension, primary aldosteronism and PPGL were ruled out. He was administered 50 mg losartan and 12.5 mg hydrochlotiazide, and his blood pressure was gradually downregulated, However, his proteinuria of about 700 mg/gram creatinine remained, and so entered a double-blind, randomized, placebo-controlled trial: the Eplerenone Combination versus Conventional Agents to Lower Blood Pressure on Urinary Antialbuminuric Treatment Effect (EVALUATE) study: (Ando K, et al. Lancet Diabetes Endocrinol. 2014; 2: 944). He was randomized to treatment with eplerenone (50 mg/day) or placebo for 52 weeks, and his assigned treatment turned out the eplerenone, associated with anti-alubuminuric effect at the end of EVALUATE study. After that, antihypertensive treatment with 25 or 50 mg eplerenone plus ARB: telmisartan or irbesartan has been continued on his agreement. He avoided excess intake of potassium-containing food, and his plasma potassium level was carefully checked every hospital visit. After 13 years, his proteinuria has not been increased (500–900 mg/gram creatinine). Nishimoto, et al. has reported that eplerenone plus renin-angiotensin system blockade may be effective for CKD in hypertensive patients, especially those with excessive salt intake by EVALUATE study (Hypertens Res 2019; 42: 514). Obesity is related to salt-sensitive hypertension (Nagae A, Fujita M, et al. Circulation 2009; 119: 978.). This obesity-related hypertensive case suggests that a mineralocorticoid receptor antagonist may improve ARB-resistant proteinuria in non-diabetic hypertension for more than 10 years, longer than EVALUATE study for about 1 year period.