The neurohormonal natural history of essential hypertension: towards primary or tertiary aldosteronism?
Use of the aldosterone-to-renin ratio has controversially suggested that approximately 10% of hypertensives have primary aldosteronism, and most of these individuals are thought to have idiopathic hyperaldosteronism. The usual renin-angiotensin system control is intact in these individuals and is similar to that in low renin and essential hypertensives, differing only in the degree of sensitivity. There is recent evidence suggesting that hyperaldosteronism relates to aldosterone synthase genetic polymorphism, and also that increased angiotensin II stimulation of the adrenal glands appears to paradoxically upregulate the receptors increasing angiotensin II sensitivity. Taken together, the possibility arises that, in susceptible hypertensives, hyperaldosteronism could be acquired. Indeed, it is well known that renin-driven renovascular hypertension is associated with the development of hyperaldosteronism. Hypothetically, within the wider hypertensive population, these findings set the scene that angiotensin II adrenal sensitivity increases over time until the secretion of aldosterone becomes "autonomous" and hence "tertiary" aldosteronism in a significant proportion of hypertensives.
Lim
Pitt O
PO
Department of Cardiology, Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, Wales, UK. limpo@cf.ac.uk
Struthers
Allan D
AD
MacDonald
Thomas M
TM
D000450:Aldosterone / Q000378:metabolism; D019405:Cytochrome P-450 CYP11B2 / Q000235:genetics / Q000378:metabolism; D018450:Disease Progression; D006801:Humans; D006929:Hyperaldosteronism / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism*; D006973:Hypertension / Q000209:etiology* / Q000378:metabolism*; D018377:Neurotransmitter Agents / Q000378:metabolism*; D011110:Polymorphism, Genetic / Q000502:physiology; D015995:Prevalence; D012083:Renin / Q000378:metabolism; D012084:Renin-Angiotensin System / Q000502:physiology; D012720:Severity of Illness Index; D013564:Sympathetic Nervous System / Q000503:physiopathology; D014655:Vascular Resistance / Q000502:physiology
D018377:Neurotransmitter Agents; D000450:Aldosterone; D019405:Cytochrome P-450 CYP11B2; D012083:Renin