The effect of renin-angiotensin system blockers on aldosterone levels in patients with chronic heart failure with preserved ejection fraction

Objective: to evaluate the effect of renin-angiotensin-aldosterone system (RAAS) blockers on aldosterone level in patients with chronic heart failure with preserved ejection fraction (HFpEF).

Materials and methods: the prospective study included 158 patients (58 men and 100 women, mean age 62,3 ± 7,4 years) with HFpEF (> 50 %) and left ventricular diastolic dysfunction. All patients had no history of primary aldosteronism and did not use the mineralocorticoid receptor antagonists during the last 6 weeks. We evaluated the duration of treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin-2 receptor antagonists (ARA-2) and its average daily dose. The dose of RAAS blockers was assessed during previous 6 months as a percentage of target. Aldosterone plasma concentration was measured and the normal level was 40 – 160 pg/ml.

Results: according to laboratory results 99 patients (62,7 %) had normal aldosterone level (nAld) and 59 patients (37,3 %) had high aldosterone level (hAld). hAld patients had significantly higher duration of RAAS blockers treatment (6 (3; 8) versus 4 (2; 5) years, p < 0,001) and dose (50 (25; 50) % vs 25 (12,5; 50) % of target, р=0,01). Multiple regression analysis showed that after standartization for age, severity of HFpEF, duration of arterial hypertension and comorbidity only long-term (more than 5 years) treatment with RAAS blockers remained the independent risk factor of high aldosterone level (odds ratio 3,16, 95 % confidence interval 2,08 – 8,24).

Conclusions: in HFpEF patients’ plasma aldosterone level is closely associated with RAAS blockers treatment. Long-term (more than 5 years) therapy with ACE inhibitors or ARA-2 is the independent risk factor of secondary hyperaldosteronism. 

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