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It’s easy to blame stress or a high-salt diet for your high blood pressure. But what if the real cause is a hormone called aldosterone?
Aldosterone helps regulate your blood pressure, but too much can raise it too high. For some people with uncontrolled hypertension, excess aldosterone may be the reason.
This article explains how aldosterone affects uncontrolled hypertension. We’ll discuss symptoms of high aldosterone levels to look out for. We’ll also talk about how doctors treat high blood pressure caused by aldosteronism.
Uncontrolled hypertension means your blood pressure stays too high. One type is resistant hypertension. This means your blood pressure stays high even though you are taking three blood pressure medications from different classes, usually including a diuretic, at the highest dose you can tolerate. It can also mean your blood pressure is controlled only with four or more medications.
About 20 percent of people with high blood pressure have resistant hypertension. Many of these people have an underlying condition causing hypertension. One cause is hyperaldosteronism (high aldosterone levels).
Aldosterone is a hormone your body uses to control your blood pressure levels. It’s made by your adrenal glands — small, triangle-shaped glands that sit on top of your kidneys. Aldosterone regulates blood pressure by changing electrolyte levels.
Sodium and potassium are key electrolytes needed for nerve and muscle function. They’re also important for controlling your fluid balance and blood pressure. When your blood pressure drops too low, your body raises it back up.
Aldosterone tells your kidneys to hold on to more sodium, and sodium likes to hold on to water. This means the higher your sodium levels are, the more water stays in your body. Your blood volume and blood pressure levels rise as a result.
The renin-angiotensin-aldosterone system (RAAS) is a complex system used to control your blood pressure levels. It uses hormones and proteins to control fluid and electrolyte levels. Problems with the RAAS can lead to high blood pressure and uncontrolled hypertension.
When your blood pressure drops, your kidneys release renin. Renin helps start a process that makes angiotensin II, a substance that narrows your blood vessels and raises blood pressure. Angiotensin II also tells the adrenal glands to release aldosterone.
Antidiuretic hormone (ADH) is a hormone that helps your body hold on to water. Along with aldosterone, it helps your kidneys keep more fluid in your body. Aldosterone also tells your kidneys to get rid of potassium in your urine, which can raise your blood pressure.
When your adrenal glands make excess aldosterone, it’s called hyperaldosteronism. Too much aldosterone can raise your blood pressure because aldosterone forces your body to hold on to more water.
As a result, the amount of fluid in your blood vessels increases. The more fluid there is, the more pressure it creates.
Hyperaldosteronism is called primary or secondary depending on the cause.
Primary hyperaldosteronism (also called primary aldosteronism) is the result of a problem with the adrenal glands themselves. Also known as Conn’s syndrome, this condition usually develops from adrenal tumors.
These adrenal tumors, called adrenal adenomas, are usually noncancerous. In rare cases, adrenal cancer can also cause Conn’s syndrome.
Some people with genetic conditions can have primary hyperaldosteronism. Congenital adrenal hyperplasia affects the development of the adrenal glands. This can lead to hormone imbalances, some of which lead to high blood pressure.
Secondary hyperaldosteronism develops when another underlying health condition affects aldosterone levels. Remember that the RAAS turns on when your kidneys sense a drop in your blood pressure.
In secondary aldosteronism, a lack of blood flow accidentally triggers the RAAS. The adrenal glands mistakenly release more aldosterone, which raises your blood pressure.
Examples of conditions that can cause secondary aldosteronism include narrowed or blocked arteries that carry blood to the kidneys and fluid buildup from conditions such as heart failure.
Hyperaldosteronism can cause uncontrolled hypertension. This condition can be tricky to diagnose. Many people with mild cases don’t show any signs.
Sometimes, the only sign may be hypertension. If your blood pressure levels get high enough, you may have:
Aldosterone also causes your body to get rid of more potassium than it should. People with hyperaldosteronism usually have hypokalemia (low potassium levels). Low potassium levels seen with hyperaldosteronism can also cause noticeable symptoms.
Potassium is important for muscle function, especially in the heart and skeletal muscles. Signs of hypokalemia to look out for include:
Doctors used to think hyperaldosteronism was fairly rare. However, as many as 25 percent of people with resistant hypertension have hyperaldosteronism. Because other conditions can cause high blood pressure, hyperaldosteronism is easy to misdiagnose.
Healthcare providers diagnose primary aldosteronism by measuring hormone levels in your blood. They compare your aldosterone and renin levels. This test is known as an aldosterone-to-renin ratio.
If the aldosterone-to-renin ratio is above 20 to 30, you may have primary aldosteronism. Imaging tests can also look for adrenal tumors causing high aldosterone levels.
Your doctor will look at your electrolyte levels with bloodwork. Abnormal electrolyte levels seen with hyperaldosteronism include:
There are a few ways doctors can lower aldosterone levels and high blood pressure. Options include medications, surgery, and lifestyle changes.
Mineralocorticoid receptor antagonists are a class of medications that block aldosterone. They help the body get rid of extra salt and water to lower blood pressure.
Spironolactone (Aldactone) is one medication doctors use. Other medications may also be used in some cases, depending on the cause of high aldosterone and your overall health. These include:
Some of these medications can raise potassium levels and cause hyperkalemia. Your doctor may check your potassium with blood tests after you start treatment.
If you have an adrenal adenoma, your doctor may recommend surgery to remove it. This is known as an adrenalectomy, which takes out one or both of your adrenal glands.
An adrenalectomy is usually a minimally invasive procedure. A surgeon makes several small cuts in your abdomen to remove one or both adrenal glands.
An adrenalectomy isn’t always a cure for uncontrolled hypertension. You may still need to take blood pressure medications.
If one adrenal gland is removed, the other usually takes over. Some people may need temporary hormone replacement. If both glands are removed, lifelong replacement therapy is needed.
Making lifestyle changes can also help control your blood pressure. Following a low-sodium diet can help reduce water retention and lower blood pressure. This is especially true for people with hyperaldosteronism who can have higher sodium levels.
Other important lifestyle changes include:
Good blood pressure control is key to staying healthy. If left untreated, uncontrolled hypertension can damage your heart and blood vessels.
Uncontrolled hypertension raises your risk of a heart attack, stroke, and heart failure. High blood pressure can also harm your kidneys, eyes, and brain.
On MyHeartDiseaseTeam, people share their experiences with heart disease, get advice, and find support from others who understand.
How do you manage aldosteronism and high blood pressure? Share your experience in the comments below.
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