Aldosterone Escape With Diuretic or Angiotensin‐Converting Enzyme Inhibitor/Angiotensin II Receptor Blocker Combination Therapy in Patients With Mild to Moderate Hypertension

Renin‐angiotensin‐aldosterone system (RAAS) hyperactivity is implicated in the development of hypertension and progressive damage in target organs. Chronic inhibition of the RAAS or use of thiazide‐type diuretics may trigger an aldosterone escape. The aim of this study was to assess this phenomenon in hypertensive patients treated with thiazide‐type diuretics (hydrochlorothiazide [HCTZ]) or single or double blockade of the RAAS (irbesartan [IRBE], quinapril [QUIN], and IRBE+QUIN). Blood pressure levels were obtained by 24‐hour ambulatory blood pressure monitoring. Plasma renin activity and aldosterone levels were determined by immunoradiometric assay. Blood pressure level was normalized in the 4 treatment groups; the HCTZ and IRBE+QUIN groups showed an increased plasma aldosterone level after 12 weeks (9.1 ±2.2 to 14.1 ±1.4 and 6.9±1.9 to 12.9±2.3 ng/dL, respectively; P