Aldosteronism and Hypertension

Abstract

A growing body of evidence suggests that hyperaldosteronism contributes significantly to the development and the severity of hypertension as well as to resistance to antihypertensive treatment. In cross-sectional analyses, plasma aldosterone levels have been shown to relate to BP levels, particularly in obese individuals. In these same individuals, BP was not related to plasma renin activity, suggesting an effect of aldosterone on BP independent of renin-angiotensin II. In a recent prospective analysis from the Framingham investigators, baseline serum aldosterone was strongly associated with development of hypertension during a 4-yr follow-up.Clin J Am Soc Nephrol 1: 1039 -1045 , 2006 . doi: 10.2215 H istorically, primary aldosteronism has been thought to be an uncommon cause of hypertension. Recent studies, however, suggest that 10 to 15% of individuals with hypertension fulfill the biochemical criteria for primary aldosteronism. Demonstration of such a high prevalence of primary aldosteronism in patients with presumed primary hypertension suggests that aldosterone excess is a common contributing cause to the development of hypertension.Primary aldosteronism is particularly common in patients with resistant hypertension, with prevalence of approximately 20%. An important role of hyperaldosteronism in contributing to the development of treatment resistance is suggested further by the broad antihypertensive benefit of aldosterone antagonists as add-on therapy in patients who are resistant to multidrug regimens. The antihypertensive benefit in this setting is not limited to patients with classically defined primary aldosteronism, suggesting aldosterone excess as a cause of resistant hypertension to a degree that is greater than is indicated by measurement of either plasma or urinary aldosterone levels. Aldosterone and Incident HypertensionMultiple, independent studies suggest that aldosterone contributes broadly to the development of hypertension separate from cases of classically defined primary aldosteronism. The role of aldosterone in causing hypertension is supported by cross-sectional studies that relate plasma aldosterone levels to ambulatory BP measurements, by prospective analyses that indicate that aldosterone levels predict development of hypertension, and by studies that confirm the broad antihypertensive efficacy of aldosterone antagonists in treating presumed primary hypertension. Importantly, in these studies, indices of renin activity were not related to BP levels, suggesting an autonomous role of aldosterone in causing hypertension that is independent of renin-angiotensin II.Cross-sectional studies demonstrate a significant correlation between plasma aldosterone and 24-h ambulatory BP levels. The relation is particularly strong in black individuals. In an analysis of black American and white French Canadian patients with primary hypertension, supine and standing plasma aldosterone levels were significantly correlated with daytime and nighttime systolic and diastolic BP levels in the black patients...

Aldosterone-to-renin ratio and nocturnal blood pressure decline in a general population

“…We observed significant associations of ARR with female sex [3,5], BMI [5,24], serum sodium [5], and nonhypercholesterolemia [21]; these findings are consistent with previous reports [3,5,21,24].…”

“…Of the 184 study participants, 94 (51.1%) had 24-h hypertension, We then classified the participants into four groups according to their ambulatory BP profile (Fig. 1) Aldosterone-to-renin ratio and nocturnal BP decline Satoh et al 1943 Table 2 Odds ratios (95% confidence intervals) for prevalence of hypertension per 1 SD increase in log plasma renin activity, log plasma aldosterone concentration, and log aldosterone-to-renin ratio 24 …”

Plasma Aldosterone Levels and Development of Insulin Resistance

“…Moreover, high plasma aldosterone levels predict the development of hypertension. 1 In view of the fact that aldosterone is a mineral corticosteroid, the association of aldosterone and hypertension is not doubted. Recently, the association between aldosterone and obesity or insulin resistance has attracted much attention.…”

Mineralocorticoid receptor‐mediated DNA damage in kidneys of DOCA‐salt hypertensive rats

“…The plasma concentration of aldosterone in these patients ranges from 0.5 to 6.3 nM, with patients suffering from congestive heart failure reaching 8 nM (2,3). Studies demonstrating the effectiveness of MR antagonism in patients with resistant hypertension, also support the high prevalence (20%) of hyperaldosteronism in this population (1,4). Aldosterone plays an important role in the pathophysiology of heart failure.…”