The Role of Aldosterone in Congestive Heart Failure

Either a 'foreward' or 'backward failure' theory has not cleary explained the pathogenesis of edema in congestive heart failure. Attention has been directed towards Aldosterone as a results of many reports that the excretion of this steroid in urine is increased in a number of diseases which are accomanied by the formation of edema as well as congestive heart failure.In the present study urinary Aldosterone was determined in patients with congestive heart failure, except for hypertensive subjects, by a modified procedure of Mattox.Relation between urinary Aldosterone and many kinds of clinical findings were investigated. In addition, successive determinations of urinary Aldosterone were made to determine how to relate this steroid to the changes of electrolyte excretion, circulatory dynamics, and other clinical findings induced by treatments.The results obtained were as follows : 1) Urinary Aldosterone was increased as the grade of failure advanced.2) A higher excretion of Aldosterone in urine of patients with right ventricular failure was observed than in those of left ventricular failure.3) There were no differences in the levels of Aldosterone excretion between patients with peripheral edema and those without.4) It was observed that there is a relation between the amounts of Aldosterone in urine and circulation time, filtrtion fraction, intra-red cellular sodium concentration and intra-red cellular Na/K ratio respectively. Inverse relation was noted among the levels of Aldosterone in urine and intra-red cellular potassium concentration, urinary Na/K ratio and urinary 17-OHCS. Observations on urinary sodium and potassium excretion, serum sodium and potassium concentration, serum Na/K ratio, and venous pressure in relation to the amounts of Aldosterone excreted in urine indicated that there is little relationship between them respectively.5) When Desoxycorticosterone acetate was administered to normal subjects and patients with congestive heart failure there were no diffeences in the mode of response to DOCA injection between the two groups except for weight gain which was much pronounced in patients with congestive heart failure.6) Successive determinations of urinary Aldosterone throughout the course of treatment disclosed that : i) coincident with diuresis or saluresis the amount of Aldosterone in urine was markedly increased. ii) in cases where the gross edema completely subsided, the levels of Aldosterone in urine were gradually decreased and venous pressure and circulation time returned to normal. In cases, however, where a favourable effect was observed on urine flow a nd electrolyte excretion but where a little edema was left on lower extremities, no decrease of urinary Aldosterone was noted and venous pressure and circulation time improved a little as compared with those in pre-treatment period.7) The effect of SC-9420 (doses about 1000 mg/day) on urine flow and electrolyte excretion in congestive heart failure was favourable, and combined administration with Hydroflumethiazide achieved marked diuresis.