Aldosterone, a New Appreciation of Its Role in Heart Failure

Abstract

Understanding of the role, triggers, and impact of the renin-angiotensin-aldosterone system in cardiovascular disease has significantly broadened. In recent years substantial discoveries have been made regarding the pathophysiology of heart failure, particularly in the area of neurohormonal activation. New interest in therapy with aldosterone antagonists was stimulated by results of a 2-year study of 1663 patients with heart failure that showed a 30% relative risk reduction of death among patients given a subhemodynamic dosage of spironolactone, a nonselective aldosterone antagonist, compared with placebo, in addition to standard therapy of diuretics, angiotensin-converting enzyme inhibitors, beta-blockers, and digitalis.

Glucocorticoid Remediable Aldosteronism: Report of a Family Pedigree and Review of the Literature

“…Studies in animals have shown that elevated aldosterone levels play an important role in the adverse remodelling of the myocardium by fibrosis, an effect which was prevented by an aldosterone antagonist (spironolactone) in the animal model irrespective of the presence of hypertension 20 . In addition, there is increasing evidence for the benefits of using aldosterone antagonists in the treatment of heart failure, including a study of 1,663 patients with heart failure that showed a 30% risk reduction of death in those given doses of spironolactone which did not alter systemic blood pressure measurements 21 ' 22 . In cerebrovascular events in patients with GRA, particularly haemorrhagic strokes, aldosterone levels have been noted to be higher in those patients with events than those without 5 .…”

Review: Aldosterone Inhibition Reduces the Risk of Sudden Cardiac Death in Patients with Heart Failure

“…7 Aldosterone is a mineralocorticoid hormone and a major effector hormone of the RAAS. 8,9 The levels of plasma aldosterone are significantly elevated in patients with untreated chronic heart failure (CHF) compared to normal controls and have a strong association with mortality. 10 Angiotensinconverting enzyme (ACE) inhibitor therapy only partially suppresses aldosterone production and 'aldosterone escape' occurs in up to 40% of patients with CHF.…”

The benefits of valsartan in the treatment of heart failure: results from Val-HeFT

“…The overall changes from baseline in aldosterone levels in the valsartan and placebo groups were −23 ± 3 and 18 ± 3 pg/ml, respectively. Elevated aldosterone levels are strongly implicated in the pathophysiology of CHF, mediating effects such as vasoconstriction, electrolyte and fluid imbalance, LV hypertrophy and myocardial fibrosis and remodelling (27).…”