A Review: Role of Aldosterone in Hypertension
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Abstract
In Western societies, hypertension affects up to 20% of the population, making it a significant public health concern. The rates of blood pressure control remain unsatisfactory despite advancements in treatment. Since hypertension is a complex disorder, there is rarely a single, obvious cause identified for so-called "essential" hypertension. The primary mineralocorticoid in humans, aldosterone is increasingly understood to contribute significantly to cardiovascular morbidity. Its role in hypertension has also been examined in view of recent research suggesting that up to 15% of hypertensive individuals exhibit a key phenotype of increased aldosterone biosynthesis, as indicated by an elevated aldosterone to renin ratio. Excessive production or activity of mineralocorticoids is a significant contributing factor to secondary hypertension. Humans' basic mineralocorticoid is aldosterone, and when an aldosterone-secreting adenoma (Conns tumour) is linked to primary aldosterone excess, it can be surgically treated. Although primary aldosteronism was once thought to be rare, recent studies have reported preval_ence rates of up to 20% among hypertensive patients. This reflects the increasing use of the plasma aldosterone concentration to renin activity ratio (ARR), which is a proxy for angiotensin II, the major trophic substance regulating aldosterone secretion. Traditionally, patients with Conns tumour present with spontaneous hypokalaemia and have a relative excess of aldosterone production with suppression of plasma levels of renin (a proxy for angiotensin II, the major trophic substance regulating aldosterone secretion).
Keywords:
Angiotensin converting enzyme inhibitor; Kidney malfunction; Hypertension; Aldosterone; Salt; Cardiovascular disease
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Audu, J. P., Chikata, E. H., Ipav, S. S., Umaru, I. J., Iseko, K. I., & Istifanus, D. K. (2024). A Review: Role of Aldosterone in Hypertension. African Journal of Biochemistry and Molecular Biology Research, 1(1), 526-546. https://doi.org/10.58578/ajbmbr.v1i1.3663
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Connell, J. M., and Davies, E. (2005). The new biology of aldosterone. Journal of Endocrinology, 186(1): 1-20.
Cunha, J. P., and Marks, J. W. (2011). High blood pressure (hypertension).
Elijovich, F., Weinberger, M. H., Anderson, C. A., Appel, L. J., Bursztyn, M., Cook, N. R., ... and Laffer, C. L. (2016). Salt sensitivity of blood pressure: a scientific statement from the American Heart Association. Hypertension, 68(3): e7-e46.
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Esler, M. (2000). The sympathetic system and hypertension. American journal of hypertension, 13(S4): 99S-105S.
Esler, M., Straznicky, N., Eikelis, N., Masuo, K., Lambert, G., and Lambert, E. (2006). Mechanisms of sympathetic activation in obesity-related hypertension. Hypertension, 48(5): 787-796.
Feldman, R. D., and Gros, R. (2013). Vascular effects of aldosterone: sorting out the receptors and the ligands. Clinical and Experimental Pharmacology and Physiology, 40(12): 916-921.
Ferreira, N. S., Tostes, R. C., Paradis, P., and Schiffrin, E. L. (2021). Aldosterone, inflammation, immune system, and hypertension. American Journal ofHhypertension, 34(1): 15-27.
Fogari, R., Preti, P., Zoppi, A., Rinaldi, A., Fogari, E., and Mugellini, A. (2007). Preval_ence of primary aldosteronism among unselected hypertensive patients: a prospective study based on the use of an aldosterone/renin ratio above 25 as a screening test. Hypertension research, 30(2): 111-117.
Forouzanfar, M. H., Afshin, A., Alexander, L. T., Anderson, H. R., Bhutta, Z. A., Biryukov, S., ... and Carrero, J. J. (2016). Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The lancet, 388(10053): 1659-1724.
Fujita, T. (2014). Mechanism of salt-sensitive hypertension: focus on adrenal and sympathetic nervous systems. Journal of the American Society of Nephrology, 25(6): 1148-1155.
Funder, J. W. (2017). Primary aldosteronism: the next five years. Hormone and Metabolic Research, 49(12): 977-983.
Galbraith, A., Bullock, S., Manias, E., Hunt, B., and Richards, A. (2015). Fundamentals of pharmacology: an applied approach for nursing and health. Routledge.
Gilman A., Hardman J.G. and Limbird L.E. (2002) Goodman and Gilman’s the pharmacological basis of therapeutics, 10th ed. New York: McGraw-Hill.
Good, D. W., George, T., and Watts III, B. A. (2006). Nongenomic regulation by aldosterone of the epithelial NHE3 Na+/H+ exchanger. American Journal of Physiology-Cell Physiology, 290(3): C757-C763.
Grassi, G. (2016). Sympathomodulatory effects of antihypertensive drug treatment. American Journal of Hypertension, 29(6): 665-675.
Grassi, G., Mark, A., and Esler, M. (2015). The sympathetic nervous system alterations in human hypertension. Circulation research, 116(6): 976-990.
Güder, G., Bauersachs, J., Frantz, S., Weismann, D., Allolio, B., Ertl, G., ... and Störk, S. (2007). Complementary and incremental mortality risk prediction by cortisol and aldosterone in chronic heart failure. Circulation, 115(13): 1754-1761.
Hiremath, S., Ruzicka, M., Petrcich, W., McCallum, M. K., Hundemer, G. L., Tanuseputro, P., ... and Sood, M. M. (2019). Alpha-blocker use and the risk of hypotension and hypotension-related clinical events in women of advanced age. Hypertension, 74(3): 645-651.
Huan, Y., DeLoach, S., Keith, S. W., Goodfriend, T. L., and Falkner, B. (2012). Aldosterone and aldosterone: renin ratio associations with insulin resistance and blood pressure in African Americans. Journal of the American Society of Hypertension, 6(1): 56-65.
Iqbal, A. M., and Jamal, S. F. (2020). Essential hypertension. Treasure Island FL.
James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., ... and Ortiz, E. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Jama, 311(5): 507-520.
Johnson, R. J., Herrera-Acosta, J., Schreiner, G. F., and Rodríguez-Iturbe, B. (2002). Subtle acquired renal injury as a mechanism of salt-sensitive hypertension. New England Journal of Medicine, 346(12): 913-923.
Kannan, A., Medina, R. I., Nagajothi, N., and Balamuthusamy, S. (2014). Renal sympathetic nervous system and the effects of denervation on renal arteries. World Journal of Cardiology, 6(8): 814.
Karch, A. M. (2019). Focus on nursing pharmacology. Lippincott Williams and Wilkins.
Kawabe, H., Azegami, T., Takeda, A., Kanda, T., Saito, I., Saruta, T., and Hirose, H. (2019). Features of and preventive measures against hypertension in the young. Hypertension Research, 42(7): 935-948.
Ksiazek, S. H., Hu, L., Andò, S., Pirklbauer, M., Säemann, M. D., Ruotolo, C., ... & Provenzano, M. (2024). Renin–Angiotensin–Aldosterone System: From History to Practice of a Secular Topic. International Journal of Molecular Sciences, 25(7): 4035.
Lewington S, Clarke R, Qizilbach N, Peto R, Collins R, Prospective Studies Collaboration. (2002). Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. The Lancet, 360(9349): 1903-1913.
Lilley L.L. and Aucker R.S. (2001) Pharmacology and the Nursing Process, 3rd ed. St Louise: Mosby.
Maaliki, D., Itani, M. M., and Itani, H. A. (2022). Pathophysiology and genetics of salt-sensitive hypertension. Frontiers in Physiology, 13: 1001434.
Maher, D., Smeeth, L., and Sekajugo, J. (2010). Health transition in Africa: practical policy proposals for primary care. Bulletin of the World Health Organization, 88(12): 943-948.
Majid, D. S., Prieto, M. C., and Navar, L. G. (2015). Salt-Sensitive Hypertension: Perspectives on Intrarenal Mechanisms. Current Hypertension Reviews, 11(1): 38–48.
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