title: Aldosterone receptor antagonists: current perspectives and therapies.
abstract: Aldosterone is a downstream effector of angiotensin II in the renin-angiotensin-aldosterone system and binds to the mineralocorticoid receptor. The classical view of aldosterone primarily acting at the level of the kidneys to regulate plasma potassium and intravascular volume status is being supplemented by evidence of new "off-target" effects of aldosterone in other organ systems. The genomic effects of aldosterone are well known, but there is also evidence for non-genomic effects and these recently identified effects of aldosterone have required a revision in the traditional view of aldosterone's role in human health and disease. The aim of this article is to review the biological action of aldosterone and the mineralocorticoid receptor leading to subsequent physiologic and pathophysiologic effects involving the vasculature, central nervous system, heart, and kidneys. Furthermore, we outline current evidence evaluating the use of mineralocorticoid receptor antagonists in the treatment of primary aldosteronism, primary hypertension, resistant hypertension, obstructive sleep apnea, heart failure, and chronic kidney disease.
authors.affiliation: University of Alabama at Birmingham, Department of Medicine, Division of Cardiovascular Disease, Birmingham, AL 35294-2041 , USA.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Guichard
authors.forename: Donald
authors.initials: D
authors.lastname: Clark
authors.forename: David A
authors.initials: DA
authors.lastname: Calhoun
authors.forename: Mustafa I
authors.initials: MI
authors.lastname: Ahmed
mesh_terms: D000450:Aldosterone / Q000378:metabolism*; D000818:Animals; D006333:Heart Failure / Q000188:drug therapy / Q000378:metabolism; D006801:Humans; D006929:Hyperaldosteronism / Q000188:drug therapy / Q000378:metabolism; D006973:Hypertension / Q000188:drug therapy / Q000378:metabolism; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D018161:Receptors, Mineralocorticoid / Q000187:drug effects* / Q000378:metabolism; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy / Q000378:metabolism; D012084:Renin-Angiotensin System / Q000187:drug effects*; D015398:Signal Transduction / Q000187:drug effects; D020181:Sleep Apnea, Obstructive / Q000188:drug therapy / Q000378:metabolism
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D018161:Receptors, Mineralocorticoid; D000450:Aldosterone
keywords: aldosterone antagonist; chronic kidney disease; heart failure; hypertension; mineralocorticoid receptor antagonist; obstructive sleep apnea; primary aldosteronism