scholarly journals Aldosterone and Its Blockade: A Cardiovascular and Renal Perspective

2006 ◽  
Vol 6 ◽  
pp. 413-424 ◽  
Author(s):  
V. Lahera ◽  
V. Cachofeiro ◽  
G. Balfagon ◽  
J.L. Rodicio

Aldosterone not only contributes to salt and water homeostasis, but also exerts direct cardiovascular and renal effects. Numerous experimental and clinical studies indicate that aldosterone participate in cardiac alterations associated with hypertension, heart failure, diabetes and other pathological entities. It is important to mention that dietary salt is a key factor in aldosterone-mediated cardiovascular damage, since damage was moreevident in animals on a high-salt diet than animals on a low salt diet. A pathophysiological action of aldosterone involves development of extracellular matrix and fibrosis, inflammation, stimulation of reactive oxygen species production, endothelial dysfunction, cell growth and proliferation. Many studies showed local extra-adrenal production of aldosterone in brain blood vessel, and the heart, which contribute in an important manner to the pathological actions of this mineralocorticoid.Several studies such as RALES, EPHESUS, 4E and others, recently showed that mineralocorticoid-receptor (MR) antagonists, alone or in combination with ACE inhibitors or ARBs, reduced the risk of progressive target organ damage and hospitalization in patients with hypertension and heart failure. These clinical benefits support the therapeutic usefulness of MR antagonists.

2019 ◽  
Vol 20 (3) ◽  
pp. 590 ◽  
Author(s):  
Aneta Paczula ◽  
Andrzej Wiecek ◽  
Grzegorz Piecha

High dietary salt intake has been listed among the top ten risk factors for disability-adjusted life years. We discuss the role of endogenous cardiotonic steroids in mediating the dietary salt-induced hypertension and organ damage.


2021 ◽  
pp. 28-30
Author(s):  
Muppala Pavani ◽  
N. Sindhura ◽  
G. Vijaya Kumar

BACKGROUND: The prevalence of hypertension and diabetes increases with age and they form major risk factors for increased morbidity and mortality rates among elderly. Ÿ The clinical presentation of hypertension and diabetes in this subgroup is somewhat different from younger group of patients Ÿ The Hospital admission rates not only depend on the increased prevalence of non communicable risk factors but also on nutritional status and socio-demographic prole in geriatric population. AIM OF THE STUDY Ÿ To study the clinical,laboratory and complication prole of elderly hypertensives and diabetes Ÿ To study associated cardiovascular risk factors and comorbid illness in them Ÿ To study the frequency ,reason for admissions to medical wards in these people. MATERIALS & METHODS: Patients aged 60 years and above, admitted to the medical wards of Santhiram medical college and hospital with either diabetes mellitus or hypertension or both were taken for the study. These patients were evaluated for the presence of cardiovascular risk factors and target organ damage. The period of the study was 6 months, Ethical Committee approval was obtained for the study. RESULTS: Half of these patients belonged to the age group of 60 – 75 years.Males being more than females by ratio of 1.5:1. Most people in this study were known hypertensive 44(69.8%) with average duration of hypertension for 3.4 years . Target organ damage was seen in 54% of these patients. Totally 44 (58.7%) patients were diabetics with average duration of diabetes for 2.6years, of them 34(77.2%) of the diabetics were centrally obese . 34(75.6%) of males were smokers and 22(48.9%) were alcoholics,43.3% of females were overweight .34.7% of patients had hypercholesterolemia. In this 68(89.3%) of the patients were found to have chronic kidney disease, study 48(64%) had cardiac complications in the form of coronary artery disease or congestive heart failure. The Major cause for hospital admissions was heart failure (33.5%). CONCLUSION: Awareness among the geriatric population on the need for early detection and treatment compliance for hypertension and diabetes is poor. This calls for community wide education on these non-communicable diseases. Cardiac complication were most common macrovascular complication among these people and most common microvascular complications being renal diseases. cardiac complications are the major cause for morbidity and mortality.


2016 ◽  
Vol 216 (2) ◽  
pp. 99-105
Author(s):  
J. Casado Cerrada ◽  
J.P. Zabaleta Camino ◽  
M. Fontecha Ortega

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fengyi Liu ◽  
Liang Wang ◽  
Yanchun Ding

Abstract Background Primary aldosteronism (PA), as a cause of secondary hypertension, can cause more serious cardiovascular damage than essential hypertension. The aldosterone-to-renin ratio (ARR) is recommended as the most reliable screening method for PA, but ARR screening is often influenced by many factors. PA cannot be easily excluded when negative ARR. Case presentation We report the case of a 45-year-old Chinese man with resistant hypertension. Three years ago, he underwent a comprehensive screening for secondary hypertension, including the ARR, and the result was negative. After that, the patient's blood pressure was still poorly controlled with four kinds of antihypertensive drugs, the target organ damage of hypertension progressed, and hypokalaemia was difficult to correct. When the patient was hospitalized again for comprehensive examination, we found that aldosterone levels had significantly increased, although the ARR was negative. An inhibitory test with saline was further carried out, and the results suggested that aldosterone was not inhibited; therefore, PA was diagnosed. We performed a unilateral adenoma resection for this patient, and spironolactone was continued to control blood pressure. After the operation, blood pressure is well controlled, and hypokalaemia is corrected. Conclusion When the ARR is negative, PA cannot be easily excluded. Comprehensive analysis and diagnosis should be based on the medication and clinical conditions of patients.


2022 ◽  
Vol 23 (2) ◽  
pp. 866
Author(s):  
Franziska E. Uhl ◽  
Lotte Vanherle ◽  
Frank Matthes ◽  
Anja Meissner

Heart failure (HF) is among the main causes of death worldwide. Alterations of sphingosine-1-phosphate (S1P) signaling have been linked to HF as well as to target organ damage that is often associated with HF. S1P’s availability is controlled by the cystic fibrosis transmembrane regulator (CFTR), which acts as a critical bottleneck for intracellular S1P degradation. HF induces CFTR downregulation in cells, tissues and organs, including the lung. Whether CFTR alterations during HF also affect systemic and tissue-specific S1P concentrations has not been investigated. Here, we set out to study the relationship between S1P and CFTR expression in the HF lung. Mice with HF, induced by myocardial infarction, were treated with the CFTR corrector compound C18 starting ten weeks post-myocardial infarction for two consecutive weeks. CFTR expression, S1P concentrations, and immune cell frequencies were determined in vehicle- and C18-treated HF mice and sham controls using Western blotting, flow cytometry, mass spectrometry, and qPCR. HF led to decreased pulmonary CFTR expression, which was accompanied by elevated S1P concentrations and a pro-inflammatory state in the lungs. Systemically, HF associated with higher S1P plasma levels compared to sham-operated controls and presented with higher S1P receptor 1-positive immune cells in the spleen. CFTR correction with C18 attenuated the HF-associated alterations in pulmonary CFTR expression and, hence, led to lower pulmonary S1P levels, which was accompanied by reduced lung inflammation. Collectively, these data suggest an important role for the CFTR-S1P axis in HF-mediated systemic and pulmonary inflammation.


2020 ◽  
Vol 52 (06) ◽  
pp. 386-393
Author(s):  
Christian Adolf ◽  
Holger Schneider ◽  
Daniel A. Heinrich ◽  
Laura Handgriff ◽  
Martin Reincke

AbstractFirst described in 1955 by Jerome W. Conn, primary aldosteronism (PA) today is well established as a relevant cause of secondary hypertension and accounts for about 5–10 % of hypertensives. The importance of considering PA is based on its deleterious target organ damage far beyond the effect of elevated blood pressure and on PA being a potentially curable form of hypertension. Aside the established contributory role of high dietary salt intake to arterial hypertension and cardiovascular disease, high salt intake is mandatory for aldosterone-mediated deleterious effects on target-organ damage in patients with primary aldosteronism. Consequently, counselling patients on the need to reduce salt intake represents a major component in the treatment of PA to minimize cardiovascular damage. Unfortunately, in PA patients salt intake is high and far beyond the target values of 5 g per day, recommended by the World Health Organization. Insufficient patient motivation for lifestyle interventions can be further complicated by enhancing effects of aldosterone on salt appetite, via central and gustatory pathways. In this context, treatment for PA by adrenalectomy results in a spontaneous decrease in dietary salt intake and might therefore provide further reduction of cardiovascular risk in PA than specific medical treatment alone. Furthermore, there is evidence from clinical studies that even after sufficient treatment of PA dietary salt intake remains a relevant prognostic factor for cardiovascular risk. This review will focus on the synergistic benefits derived from both blockade of aldosterone-mediated effects and reduction in dietary salt intake on cardiovascular risk.


2018 ◽  
Vol 127 (02/03) ◽  
pp. 100-108 ◽  
Author(s):  
Yuhong Yang ◽  
Martin Reincke ◽  
Tracy Williams

AbstractThe importance of an early diagnosis and appropriate management of patients with primary aldosteronism (PA) has become increasingly clear because of the adverse impact of the disorder on cardiovascular and cerebrovascular events and target organ damage. Adrenalectomy potentially cures patients with unilateral PA resulting in normalisation of blood pressure or significant clinical improvements in the majority of patients. Different criteria have been used to evaluate outcomes of unilateral adrenalectomy. Clinical remission (cure of hypertension) is observed in 6% to 86% of patients and clinical benefits from surgery are seen in the majority. Several factors have been identified that predict clinical success after surgery such as age, sex, anti-hypertensive medication dosage and known duration of hypertension. Biochemical remission of PA after unilateral adrenalectomy, characterised by the resolution of hyperaldosteronism and correction of pre-surgical hypokalaemia, is observed in 67% to 100% of patients with unilateral PA. In only a small proportion of patients, adrenalectomy fails to resolve hyperaldosteronism and inappropriate aldosterone production persists after surgery. In this review we discuss the potential reasons for failing to cure hyperaldosteronism after unilateral adrenalectomy for unilateral primary aldosteronism.


2019 ◽  
Vol 6 (3) ◽  
pp. 122-131
Author(s):  
T. Ashcheulova ◽  
T. Ambrosova ◽  
O. Kochubiei ◽  
O. Honchar ◽  
I. Sytina

Abstract. SUBCLINICAL CARDIAC DAMAGE IN CARDIOPULMONARY POLYMORBIDITY (Review. Part 2) Ashcheulova T., Ambrosova T., Kochubiei O., Honchar O., Sytina I. Hypertension and chronic obstructive pulmonary disease are frequent comorbid conditions in the internal medicine and are subject to meaningful cooperation among physicians, cardiologists, and pulmonologists. A combination of chronic obstructive pulmonary disease and hypertension presents certain diagnostic and therapeutic challenges. These conditions share common risk factors, similar clinical presentations and some common parts of pathogenesis. A problem of association between chronic obstructive pulmonary disease and hypertension may be currently discusses both as a simple combination of various clinical entities, and as chronic obstructive pulmonary disease resulting in development of factors contributing to hypertension. One way or another, either a simple combination, or a mutually aggravating syndrome, but we state there is a cardiorespiratory continuum where chronic obstructive pulmonary disease acts as a valid component of hypertension development, and vice versa. Thus, it seems to be relevant to study peculiarities of the structural and functional status of the cardiovascular system and microcirculation, systemic remodeling mechanisms, endothelial dysfunction and inflammation in presence of chronic obstructive pulmonary disease-associated hypertension. Problems of additional cardiovascular risk marker development, treatment efficiency assessment remain topical. The use of electrocardiography and echocardiography with dopplerometry has been an important diagnostic principle of subclinical cardiovascular damage in presence of hypertension and chronic obstructive pulmonary disease comorbidity. Non-invasive imaging methods play a central part in diagnosis of subclinical target organ damage. Wide implementation thereof is based on high diagnostic accuracy, common availability, safety and relatively low price. Key words: hypertension, chronic obstructive pulmonary disease, comorbidity, electrocardiography, echocardiography with dopplerometry   Резюме. СУБКЛІНІЧНЕ УРАЖЕННЯ СЕРЦЯ ПРИ КАРДІОПУЛЬМОНАЛЬНІЙ ПОЛІМОРБІДНОСТІ (Огляд. Частина 2). Ащеулова Т.В., Амбросова Т.М., Кочубєй О.А., Гончарь О.В., Ситіна І.В. Артеріальна гіпертензія і хронічне обструктивне захворювання  легень - одне з частих коморбідних станів в клініці внутрішніх хвороб і є предметом конструктивної взаємодії терапевтів, кардіологів, пульмонологів. Поєднання хронічного обструктивного захворювання  легень і артеріальної гіпертензії являє певні труднощі для діагностики і лікування. Ці захворювання мають загальні фактори ризику, схожі клінічні прояви і спільність деяких ланок патогенезу.  Таким чином, представляється актуальним дослідження особливостей структурно-функціонального стану серцево-судинної системи і мікроциркуляції, вивчення системних механізмів ремоделювання, ендотеліальної дисфункції та запалення при артеріальній гіпертензії в поєднанні з хронічним обструктивним захворюванням  легень. Залишаються актуальними питання розробки додаткових маркерів серцево-судинного ризику, оцінки ефективності проведеного лікування. В останні роки важливими принципами діагностики субклінічного ураження серця і судин при коморбідності хронічного обструктивного захворювання  легень і артеріальної гіпертензії є використання електрокардіографії та ехокардіографії з доплерометрією. Неінвазивні методи візуалізації відіграють центральну роль в діагностиці субклінічного ураження органів-мішеней. Їх широке застосування обумовлено високою діагностичної точністю, повсюдною поширеністю, безпекою і відносно низькою вартістю. Ключові слова. Артеріальна гіпертензія, хронічне обструктивне захворювання легень, коморбідность, електрокардіографія, ехокардіографія з доплерометрією.   Резюме. СУБКЛИНИЧЕСКОЕ ПОРАЖЕНИЕ СЕРДЦА ПРИ КАРДИОПУЛЬМОНАЛЬНОЙ ПОЛИМОРБИДНОСТИ (Обзор. Часть 2). Ащеулова Т.В., Амбросова Т.Н., Кочубей О.А., Гончарь А.В., Сытина И.В. Артериальная гипертензия и хроническое обструктивное заболевание легких  - одно из частых коморбидных состояний в клинике внутренних болезней и являются предметом конструктивного взаимодействия терапевтов, кардиологов, пульмонологов. Сочетание хронического обструктивного заболевания легких и артериальной гипертензии представляет определенные трудности для диагностики и лечения. Эти заболевания имеют общие факторы риска, схожие клинические проявления и общность некоторых звеньев патогенеза. Таким образом, представляется актуальным исследование особенностей структурно-функционального состояния сердечно-сосудистой системы и микроциркуляции, изучение системных механизмов ремоделирования, эндотелиальной дисфункции и воспаления при артериальной гипертензии в сочетании с хроническим обструктивным заболеванием легких. Остаются актуальными вопросы разработки дополнительных маркеров сердечно-сосудистого риска, оценки эффективности проводимого лечения. В последние годы важными принципами диагностики субклинического поражения сердца и сосудов при коморбидности хронического обструктивного заболевания легких и артериальной гипертензии является использование электрокардиографии и эхокардиографии с допплерометрией. Неинвазивные методы визуализации играют центральную роль в диагностике субклинического поражения органов-мишеней. Их широкое применение обусловлено высокой диагностической точностью, повсеместной распространенностью, безопасностью и относительно низкой стоимостью. Ключевые слова. Артериальная гипертензия, хроническое обструктивное заболевание легких, коморбидность, электрокардиография, эхокардиография с допплерометрией.


2019 ◽  
Vol 20 (4) ◽  
pp. 798 ◽  
Author(s):  
Speranza Rubattu ◽  
Maurizio Forte ◽  
Simona Marchitti ◽  
Massimo Volpe

The pathogenesis of hypertension, as a multifactorial trait, is complex. High blood pressure levels, in turn, concur with the development of cardiovascular damage. Abnormalities of several neurohormonal mechanisms controlling blood pressure homeostasis and cardiovascular remodeling can contribute to these pathological conditions. The natriuretic peptide (NP) family (including ANP (atrial natriuretic peptide), BNP (brain natriuretic peptide), and CNP (C-type natriuretic peptide)), the NP receptors (NPRA, NPRB, and NPRC), and the related protease convertases (furin, corin, and PCSK6) constitute the NP system and represent relevant protective mechanisms toward the development of hypertension and associated conditions, such as atherosclerosis, stroke, myocardial infarction, heart failure, and renal injury. Initially, several experimental studies performed in different animal models demonstrated a key role of the NP system in the development of hypertension. Importantly, these studies provided relevant insights for a better comprehension of the pathogenesis of hypertension and related cardiovascular phenotypes in humans. Thus, investigation of the role of NPs in hypertension offers an excellent example in translational medicine. In this review article, we will summarize the most compelling evidence regarding the molecular mechanisms underlying the physiological and pathological impact of NPs on blood pressure regulation and on hypertension development. We will also discuss the protective effect of NPs toward the increased susceptibility to hypertensive target organ damage.


2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Kristin Kräker ◽  
Florian Herse ◽  
Michaela Golic ◽  
Nadine Reichhart ◽  
Sergio Crespo-Garcia ◽  
...  

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