Aldosterone and Hypertension

Hypertension is one of the leading causes of death worldwide and the primary risk factor for ischemic and hemorrhagic strokes and coronary artery disease. The role of aldosterone and mineralocorticoid receptor (MR) in hypertension has been extensively discussed. This chapter discussed the role of aldosterone and MR in primary hypertension, excluding primary aldosteronism. An increasing body of evidence suggests that aldosterone production on a liberal salt diet may be increased, independent of renin levels, even in the absence of a classical phenotype of primary aldosteronism. This phenomenon occurs in a sizable minority of hypertensive populations and even in individuals without a blood pressure in the hypertensive range. Thus, these data support a broader role for MR antagonists in hypertensive patients without suggestive evidence of primary aldosteronism. Data supportive of this concept have come from clinical trials where MR antagonists are as effective as other classes of agents in the treatment of primary hypertension. Further, MR antagonists are the most effective add-on agents in patients with resistant hypertension. Finally, we proposed a genetic approach to simplify the identification of individuals with aldosterone/MR dysfunction who may benefit from MR antagonist treatment—personalized therapy.