TREATMENT of essential hypertension with thiazide diuretics or chlorthalidone offers satisfactory therapy to most patients. Side effects are exceptional and usually not clinically significant. The occasionally noted inadequate antihypertensive effect or drug-induced hypokalemic alkalosis, hyperglycemia, or hyperuricemia spur a continued search for improved therapy.
Most investigators,1-4 but not all,5 have found a competitive antagonist of aldosterone, spironolactone, to be antihypertensive and free of significant clinical or biochemical side effects. The reported studies are characterized by low dosage or brief duration.
There has been a recent reemphasis of possible adrenal cortical pathology in a substantial proportion of hypertensive patients. Previous studies6-7 have noted increased aldosterone excretion in most patients with hypertension, although recent work has not confirmed this in mild disease.8 Small adrenal cortical adenomas have been detected in approximately one fifth of patients with essential hypertension.9 Although these tumors usually have been considered functionally unimportant, it is intriguing that considerable