Aldosterone and the Metabolic Syndrome

The purpose of this study is to determine the effects of mineralocorticoid receptor (MR)
antagonism and renin inhibition on fasting blood glucose and glucose-stimulated insulin
secretion in humans.

Inclusion Criteria:

- Subjects meeting all of the following conditions will be included in the study:

1. Ambulatory subjects, 18 to 70 years of age, inclusive

2. For female subjects, the following conditions must be met:

1. postmenopausal status for at least 1 year, or

2. status-post surgical sterilization, or

3. if of childbearing potential, utilization of adequate birth control and
willingness to undergo urine beta-hcg testing prior to drug treatment and on
every study day.

3. A seated or supine systolic blood pressure greater than 130/85 on three separate
measurements at least 15 minutes apart

4. Metabolic Syndrome as defined by the presence of > 3 of the following:

1. Hypertension as characterized by having Systolic Blood Pressure > 140 mm Hg
and Diastolic Blood Pressure > 90 mm Hg.

2. Impaired Glucose Tolerance (Fasting Plasma Glucose > 100 mg/dL)

3. Increased triglyceride level > 150mg/dL

4. Decreased levels of High-Density Lipoprotein (HDL) cholesterol

1. For males, less than 30 mg/dL

2. For females, less than 40 mg/dL

5. Waist circumference

1. For males, greater than 40 inches.

2. For females, greater than 35 inches.

Exclusion Criteria:

- Subjects presenting with any of the following will not be included in the study:

1. Diabetes type 1 or type 2, a fasting glucose of greater than 110 mg/dL or the use
of anti-diabetic medication

2. Use of hormone replacement therapy

3. Statin therapy

4. Pregnancy

5. Breast-feeding

6. Cardiovascular disease such as prior myocardial infarction, presence of angina
pectoris, significant arrhythmia, congestive heart failure [Left Ventricular (LV)
hypertrophy acceptable], deep vein thrombosis, pulmonary embolism, second or
third degree heart block, mitral valve stenosis, aortic stenosis or hypertrophic
cardiomyopathy

7. Treatment with anticoagulants

8. History of serious neurologic disease such as cerebral hemorrhage, stroke,
seizure, or transient ischemic attack

9. History or presence of immunological or hematological disorders

10. Diagnosis of asthma requiring use of inhaled beta agonist >1 time per week

11. Clinically significant gastrointestinal impairment that could interfere with drug
absorption

12. Impaired hepatic function [aspartate amino transaminase (AST) and/or alanine
amino transaminase (ALT) >1.5 x upper limit of normal range]

13. Impaired renal function [estimated glomerular filtration rate (eGFR) of
<60ml/min] as determined by the four-variable Modification of Diet in Renal
Disease (MDRD) equation, where serum creatinine (Scr) is expressed in mg/dl and
age in years:

eGFR (ml/min/1.73m2)=175 • Scr-1.154 • age-0.203 • (1.212 if black) • (0.742 if
female)

14. Hematocrit <35%

15. Any underlying or acute disease requiring regular medication which could possibly
pose a threat to the subject or make implementation of the protocol or
interpretation of the study results difficult, such as arthritis treated with
non-steroidal antiinflammatory drugs

16. Treatment with chronic systemic glucocorticoid therapy (more than 7 consecutive
days in 1 month)

17. Treatment with lithium salts

18. History of alcohol or drug abuse

19. Treatment with any investigational drug in the 1 month preceding the study

20. Mental conditions rendering the subject unable to understand the nature, scope
and possible consequences of the study

21. Inability to comply with the protocol, e.g., uncooperative attitude, inability to
return for follow-up visits, and unlikelihood of completing the study

22. Screening plasma potassium <3.2 mmol/L or use of chronic potassium supplements
for the treatment of hypokalemia