Academic Journal
Pathophysiology of aldosterone dysregulation in difficult-to-control hypertension.
| Τίτλος: | Pathophysiology of aldosterone dysregulation in difficult-to-control hypertension. |
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| Συγγραφείς: | Borghi C; Department of Cardiovascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Fogacci F; Department of Cardiovascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Cicero AFG; Department of Cardiovascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. |
| Πηγή: | American journal of hypertension [Am J Hypertens] 2026 Oct 01; Vol. 39 (Supplement_1), pp. S11-S17. |
| Τύπος έκδοσης: | Journal Article; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Oxford University Press Country of Publication: United States NLM ID: 8803676 Publication Model: Print Cited Medium: Internet ISSN: 1941-7225 (Electronic) Linking ISSN: 08957061 NLM ISO Abbreviation: Am J Hypertens Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2013- : Oxford : Oxford University Press Original Publication: [New York, NY] : Elsevier, [c1988- |
| Ιατρικοί όροι (MeSH): | Aldosterone*/metabolism , Aldosterone*/blood , Hypertension*/physiopathology , Hypertension*/drug therapy , Hypertension*/etiology , Hypertension*/metabolism , Renin-Angiotensin System*/drug effects , Renin-Angiotensin System*/physiology , Hyperaldosteronism*/physiopathology , Hyperaldosteronism*/complications , Blood Pressure*/drug effects , Hypoaldosteronism*/physiopathology , Hypoaldosteronism*/complications, Receptors, Mineralocorticoid/metabolism ; Antihypertensive Agents/therapeutic use ; Humans ; Animals ; Risk Factors |
| Περίληψη: | Aldosterone, a key component of the renin-angiotensin-aldosterone system (RAAS), plays a central role in sodium balance, vascular tone, blood pressure control, and cardiovascular remodeling. Dysregulation of aldosterone mechanism, including excessive production, deficiency, and inappropriate receptor activation, represents a significant contributor to cardiovascular and renal disease which is often underrecognized. Aldosterone dysregulation may manifest as primary aldosteronism that is increasingly identified as a common cause of secondary hypertension, or by secondary hyperaldosteronism that reflects maladaptive responses in common clinical conditions such as heart failure and liver cirrhosis. Conversely, hypoaldosteronism, particularly in diabetic nephropathy, predisposes to hyperkalemia and metabolic acidosis. Furthermore, aldosterone dysregulation can be observed in many clinically important and common patient phenotypes such as older patients, obese, and patients with diabetes where the elevated levels of aldosterone can contribute to poor blood pressure control and development of target organ damage particularly at the cardiac, vascular, and renal level. Beyond circulating levels of aldosterone itself, mineralocorticoid receptor (MR) overactivation in the absence of elevated aldosterone highlights the complexity of tissue-specific signaling. This review summarizes the spectrum of aldosterone dysregulation, delineates key patient phenotypes, and discusses diagnostic and therapeutic implications with a focus on cardiovascular outcomes. Recognizing aldosterone dysregulation as a systemic cardio-renal-metabolic disorder has important implications for risk stratification and targeted therapies. (© The Author(s) 2026. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.) |
| Contributed Indexing: | Keywords: RAAS; aldosterone; blood pressure; heart failure; hyperkalemia; hypertension; mineralocorticoid receptor; primary aldosteronism |
| Substance Nomenclature: | 4964P6T9RB (Aldosterone) 0 (Receptors, Mineralocorticoid) 0 (Antihypertensive Agents) |
| Entry Date(s): | Date Created: 20261008 Date Completed: 20261008 Latest Revision: 20261008 |
| Update Code: | 20261009 |
| DOI: | 10.1093/ajh/hpag082 |
| PMID: | 42847229 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1941-7225 |
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| DOI: | 10.1093/ajh/hpag082 |