Browsing by Author "Montero L J."

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    11β-hydroxysteroid dehydrogenase activity in patients with hypertension and low plasma renin activityActividad de 11 beta hidroxiesteroide dehidrogenasa tipo 2 en hipertensos chilenos
    (2002) Fardella B C.; Mosso G L.; Carvajal M C.; Campino J C.; Rojas O A.; González P A.; Barraza M A.; Montero L J.; NCD Risk Factor Collaboration (NCD-RisC)
    Background: Half of hypertensive patients with low plasma renin activity have a primary hyperaldosteronism. Among the remaining half, 11β-hydroxysteroid dehydrogenase type 2 (11βHSD2) deficiency plays an important role. This enzyme catalyzes the conversion of cortisol to cortisone, avoiding the interaction of cortisol with the mineralocorticoid receptor. If the enzyme fails, cortisol will stimulate sodium and water reabsorption and increase blood pressure. Aim: To determine biochemical alterations, suggestive of 11βHSD2 deficiency, in low-renin hypertensive patients. Patients and Methods: Twenty eight hypertensive patients with a plasma renin activity of less than 0.5 ng/ml/h and with a plasma aldosterone of less than 5 ng/dl were studied. Twenty eight normotensive patients were studied as controls. Serum cortisol (RIA), cortisone (ELISA) and the serum cortisol/cortisone ratio were determined in all of them, between 9 and 10 AM. Measurements were confirmed by high pressure liquid chromatography. The serum cortisol/cortisone ratio was considered abnormal when its Ln (cortisol/cortisone) value was over 2 standard deviations of the mean. Results: Serum cortisol was higher in hypertensive subjects than in controls (11.1±3.3 and 9.2±2.8 μg/dl, respectively; p <0.05). No differences were observed in serum cortisone (3.4±1.3 and 3.7±1.2 μg/dl, respectively). Four hypertensive subjects had an abnormally high Ln (cortisol/cortisone) value (1.86; 1.73; 2.07 and 2.01, considering a normal value of less than 1.61). Conclusions: Four of 28 hypertensive subjects with low plasma renin activity and aldosterone had biochemical alterations suggestive of 11βHSD2 deficiency (Rev Méd Chile 2002; 130: 1201-8).
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    Glucocorticoid treatable hypertension. Report of one caseHipertensión arterial tratable con glucocorticoides: Comunicación de un caso
    (1997) Montero L J.; Fardella B C.; Mosso G L.; Fardella B C.
    Lately, a series of hypertensive syndromes of unknown etiology that respond to new forms of therapy, have been described. One of these is glucocorticoid remediable hypertension, that evolves with suppressed plasma renin activity and normal or high serum aldosterone levels, that lead to an aldosterone/plasma renin activity ratio over 30. We report a 45 years old woman with a severe hypertension, despite the use of antihypertensive medications. She had a plasma renin activity of less than 0.3 ng/ml/h, normal serum aldosterone levels (10 ng/ml) and thus a high aldosterone/plasma renin activity ratio. She had normal serum potassium and sodium levels. Due to the bad results of conventional antihypertensive medications, a treatment with dexamethasone was started, that normalized blood pressure and allowed to discontinue other antihypertensive medications. This type of hypertension must be sought since non conventional treatments could be used for refractory hypertensive syndromes.