Mechanisms of hypertension: the expanding role of aldosterone

Freel, E.M. and Connell, J.M.C. (2004) Mechanisms of hypertension: the expanding role of aldosterone. Journal of the American Society of Nephrology, 15(8), pp. 1993-2001. (doi: 10.1097/01.ASN.0000132473.50966.14)

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Hypertension is a common disorder that affects a large heterogeneous patient population. Subgroups can be identified on the basis of their responses to hormonal and biologic stimuli. These subgroups include low-renin hypertensives and nonmodulators. Aldosterone, the principal human mineralocorticoid, is increasingly recognized as playing a significant role in cardiovascular morbidity, and its role in hypertension has recently been reevaluated with studies that suggest that increased aldosterone biosynthesis (as defined by an elevated aldosterone to renin ratio) is a key phenotype in up to 15% of individuals with hypertension. It was reported previously that a polymorphism of the gene (C to T conversion at position −344) encoding aldosterone synthase is associated with hypertension, particularly in individuals with a high ratio. However, the most consistent association with this variant is a relative impairment of adrenal 11β-hydroxylation. This review explores the evidence for this and provides a hypothesis linking impaired 11β-hydroxylation and hypertension with a raised aldosterone to renin ratio. It is also speculated that there is substantial overlap between this group of patients and previously identified low-renin hypertensives and nonmodulators. Thus, these groups may form a neurohormonal spectrum reflecting different stages of hypertension or indeed form sequential steps in the natural history of hypertension in genetically susceptible individuals.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Connell, Professor John and Freel, Dr Marie
Authors: Freel, E.M., and Connell, J.M.C.
College/School:College of Medical Veterinary and Life Sciences
Journal Name:Journal of the American Society of Nephrology
ISSN (Online):1533-3450

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