Hypertension and anti-hypertensive therapy in Menière's disease

Background: Endolymphatic hydrops is the main physiological correlate of Menière's disease (MD). The endolymphatic sac expresses aldosterone-regulated proteins analogous to those in nephrons. The aim of the study was to assess the prevalence of hypertension in MD and evaluate a correlation between antihypertensive drugs and the course of the disease. Methods: 89 patients with definite MD, mean age: 57.2±15.4 years; 48 male (54%). Crises in the last 12 months, the hearing ability (PTA4), the state of the disease (active/stable), symptoms, hypertension, and anti-hypertensive medications were collected. Results: Fifty-one percent of patients were hypertensive; 77% of hypertensives took chronic antihypertensive therapy: RAAS inhibitory, (25%); diuretics (16%); beta-blockers (15%); association (29%). The disease was active in 38% of the subjects. Hypertensive patients were older (63.8±11.4 vs 50.4±16.2, P=<0.001) and showed a higher PTA4 in both the affected and contralateral ear (60.8±20.5 vs 45.4±20.4, P= 0.0009). There was no significant difference in the prevalence of symptoms or in the detection of endolymphatic hydrops on MRI between hypertensive and normotensive patients. In patients taking antihypertensive therapy, the number of crises was comparable in both patients in therapy with RAAS inhibitor drugs and in patients on beta-blocker therapy. In hypertensive patients on diuretics the number of crises was lower (12.7±7.2 vs 6.3±5.4, P= 0.01). Conclusion: It is possible that hypertension plays an important role in the development of related symptoms to Meniere's disease. The use of diuretics was associated with reduced clinical manifestations of the disease.