Published online before print June 16, 2008, doi: 10.1161/HYPERTENSIONAHA.108.111211
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(Hypertension. 2008;52:207.)
© 2008 American Heart Association, Inc.
Editorial Commentaries |
Aldosterone, Hypertension, and Cardiovascular Disease
An Endless Story
From the Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain.
Correspondence to Luís M. Ruilope, Unidad de Hipertensión, Hospital 12 de Octubre, Avda Cordoba s/n, 28041 Madrid, Spain. E-mail ruilope@ad-hocbox.com
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
A growing body of evidence has related the existence of an excess of aldosterone and the development and progression of cardiovascular (CV) and renal disease. The list of processes where the mineralocorticoid is involved in an independent manner includes arterial hypertension, congestive heart failure, chronic kidney disease, coronary artery disease, and stroke.1
The association with aldosterone is particularly strong for arterial hypertension. The initial description by Conn2 of primary aldosteronism proved the existence of a direct relationship between elevated levels of aldosterone and the development of hypertension. Such an association was initially considered a rare cause of secondary hypertension, with a prevalence <1%. However, recent data indicate the possible existence of an unrecognized epidemic of primary aldosteronism. In fact, a prospective study by Rossi et al3 investigated a group of 1125 patients and, through a carefully performed protocol, concluded that 11.2% presented with a primary hyperaldosteronism. Primary aldosteronism implies excessive organ damage to the heart, vessels, and kidney, which facilitates a higher frequency of CV events,4 and if its real prevalence is higher than reported previously, its contribution to the final consequences of CV and renal disease in the hypertensive population could be very relevant.
The contribution of aldosterone to the development of arterial hypertension in the general population has been shown recently by the Framingham Offspring Study in which serum plasma aldosterone levels in normotensive subjects predicted subsequent increases in blood pressure and in the development of incident hypertension.5 A role of aldosterone in arterial hypertension is also suggested
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