Excess aldosterone production has been the focus of what was thought to be a relatively uncommon condition; we now know that was an incorrect assumption. Additionally, it is now known that aldosterone synthesis could occur outside of the adrenals, by visceral adipocytes for example, which was not fully appreciated until the last decade. Several studies have reported mineralocorticoid receptor (MR) expression outside of the classical aldosterone-sensitive distal nephron in the kidney, including the heart (cardiomyocyte, fibroblasts, and vessels), (endothelial cells and smooth muscle cells), and inflammatory cells (T cells, macrophages, and dendritic cells). Much work has been done to elucidate the mechanisms responsible for MR activation as a mediator of oxidative stress, cell activation for inflammation, and pro-inflammatory and fibrotic responses. Taken together, these studies suggest that aldosterone levels need to be assessed in all patients at risk for and/or in the presence of cardiorenal disease, especially if they have central obesity and/or resistant hypertension. We now have relatively safe and better-tolerated agents than traditional steroidal agents that can and should be used to reduce cardiorenal risk in these groups of patients.
Authors: George L Bakris, Frederic Jaisser
DOI Number: 10.1093/eurheartj/ehac410 Publication Year: 2022
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