The role of aldosterone in resistant hypertension: implications for pathogenesis and therapy.
Resistant hypertension constitutes an increasingly common medical disorder. Although the exact incidence is not precisely known, estimates derived from recent outcome studies emphasize that resistant hypertension is much more common than previously thought. A major advance in our understanding of its pathogenesis and management is the recent recognition of the importance of aldosterone excess or autonomy as an important mechanism for drug resistance in hypertension. Recent studies of the effects of aldosterone on vascular smooth muscle have delineated several extra-renal mechanisms whereby aldosterone produces hypertension primarily by its direct vasoconstrictor effects and by altering vascular compliance. Consequently, aldosterone blockade constitutes an effective intervention for treating resistant hypertension.
Epstein
Murray
M
Professor of Medicine, Nephrology Section, VA Medical Center, Miami, FL 33125, USA. murraye@gate.net
Calhoun
David A
DA
D000450:Aldosterone / Q000097:blood / Q000378:metabolism*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism*; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D012720:Severity of Illness Index
D000959:Antihypertensive Agents; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D000450:Aldosterone