Aldosterone and arterial hypertension.
In the setting of primary aldosteronism, elevated aldosterone levels are associated with increased blood pressure. Aldosterone concentrations within the normal range, however, can also alter blood pressure. Furthermore, the aldosterone-to-renin ratio, an indicator of aldosterone excess, is associated with hypertension, even in patients without excessive absolute aldosterone levels. In this Review we assess the data on the role of aldosterone in the development and maintenance of hypertension. We provide an overview of the complex crosstalk between genetic and environmental factors, and about aldosterone-mediated arterial hypertension and target organ damage. The discussion is organized according to major targets of aldosterone action: the collecting duct in the kidney, the vasculature and the central nervous system. The antihypertensive efficacy of mineralocorticoid-receptor blockers, even in patients with aldosterone values in the normal range, supports the evidence that aldosterone plays a part in blood pressure elevation in the absence of primary aldosteronism.
Tomaschitz
Andreas
A
Division of Endocrinology and Nuclear Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria. andreas.tomaschitz@gmx.at
Pilz
Stefan
S
Ritz
Eberhard
E
Obermayer-Pietsch
Barbara
B
Pieber
Thomas R
TR
D000450:Aldosterone / Q000235:genetics / Q000494:pharmacology / Q000502:physiology; D000818:Animals; D000959:Antihypertensive Agents; D001794:Blood Pressure; D001808:Blood Vessels / Q000187:drug effects; D001921:Brain / Q000187:drug effects; D019405:Cytochrome P-450 CYP11B2 / Q000235:genetics; D005006:Ethnicity; D020022:Genetic Predisposition to Disease; D006706:Homeostasis; D006801:Humans; D006929:Hyperaldosteronism; D006973:Hypertension / Q000209:etiology / Q000235:genetics; D007685:Kidney Tubules, Collecting / Q000187:drug effects; D000451:Mineralocorticoid Receptor Antagonists; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System
D000959:Antihypertensive Agents; D000451:Mineralocorticoid Receptor Antagonists; D000450:Aldosterone; D019405:Cytochrome P-450 CYP11B2; D012083:Renin