Avaliação do bloqueio da aldosterona sobre parâmetros metabólicos e renais na síndrome metabólica

Abstract

Introduction: Although aldosterone has been implicated in the pathophysiology not only of the metabolic syndrome (MS) but also of the MS-associated arterial hypertension, the use of mineralocorticoid receptor antagonists in these situations has been little studied. Objectives: Assess the effects of mineralocorticoid blockade on the pressoric behavior and metabolic and renal parameters of individuals with the MS in comparison with a control group on amlodipine. Methods: 27 individuals with the MS were assessed in a prospective study consisting of two periods: baseline (2 weeks), during which demographic data were obtained and all anti-hypertensive medication withdrawn, and treatment period, during which spironolactone (25 to 50 mg/day) or amlodipine (5 to 10 mg/day) were administered for 16 weeks. Individuals had their metabolic, inflammatory and renal parameters assessed, and underwent 24-hour ambulatory blood pressure monitoring during both study periods. Results: After the groups were paired, 16 individuals were enrolled in the spironolactone group and 11 in the amlodipine group (controls). After the intervention, there was a significant decrease of both the 24-hour systolic (-23.98 mmHg, CI:-34.85 to -13.11, in the spironolactone group, and -14.36 mmHg, CI: -25.83 to 2.89, in the amlodipine group) and diastolic pressure (-12.84 mmHg, CI: -9.82 to -5.87, in the spironolactone group and -9.59 mmHg, CI: -16.97 to – 2.21, in the amlodipine group. As for the metabolic profile, there was a significant increase of HDL-cholesterol in the spironolactone group (p=0.001), regardless of the degree of inflammation, without significant alterations in the amlodipine group. There were no significant alterations in the Homeostasis Model Assessment (HOMA-IR), triglycerides and potassium in both groups. There was also a significant albuminuria reduction in the spironolactone group, without significant alterations in the amlodipine group, along with a significant reduction of C-reactive protein in the spironolactone group and a significant increase of C-reactive protein in the amlodipine group. Conclusion: Spironolactone as monotherapy for hypertensive individuals with the metabolic syndrome showed efficacy in blood pressure control, had additional metabolic benefits, such as an increase of HDLcholesterol and reduction of C-reactive protein, and showed a renal protective effect through albuminuria reduction.