Correct Answer

Once a definitive diagnosis of primary hyperaldosteronism has been made, it would be appropriate to add an aldosterone receptor antagonist. According to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7), in a patient with uncomplicated hypertension, the target BP is less than 140/90 mmHg, although the risk of cardiovascular diseases begins at a BP of 115/75 mmHg and doubles with each 20/10 mmHg increment.

If this patient had comorbidities such as diabetes or chronic renal disease, a target blood pressure of less than 130/80 mmHg would have been recommended.

Until recently, spironolactone, a non-selective aldosterone receptor antagonist, was the only available drug of its class. Eplerenone is a novel selective aldosterone receptor antagonist with the efficacy of spironolactone, but with far fewer side effects related to blockade of sex hormone receptors, for example gynecomastia, impotence and menstrual irregularities. The drug has not yet been released on the market in UK but it is available in the US. It has been shown to be effective in both Black and White patients, lowering systolic and diastolic blood pressures.

In addition to pharmacologic management, it is recommended that this patient adopt a healthy lifestyle to maintain a normal weight (BMI 18.5–24.9 kg/m2). For example, she should adopt the Dietary Approaches to Stop Hypertension (DASH) eating plan, which is rich in calcium and potassium. She needs to exercise regularly, restrict salt intake (less than 100 mmol/day) and limit alcohol consumption to one drink daily.