Primary Aldosteronism and Resistant Hypertension: A Pathophysiological Insight.
Fabio BiolettoMartina BollatiChiara LopezStefano ArataMatteo ProcopioFederico PonzettoEzio GhigoMauro MaccarioMirko Parasiliti CaprinoPublished in: International journal of molecular sciences (2022)
Primary aldosteronism (PA) is a pathological condition characterized by an excessive aldosterone secretion; once thought to be rare, PA is now recognized as the most common cause of secondary hypertension. Its prevalence increases with the severity of hypertension, reaching up to 29.1% in patients with resistant hypertension (RH). Both PA and RH are "high-risk phenotypes", associated with increased cardiovascular morbidity and mortality compared to non-PA and non-RH patients. Aldosterone excess, as occurs in PA, can contribute to the development of a RH phenotype through several mechanisms. First, inappropriate aldosterone levels with respect to the hydro-electrolytic status of the individual can cause salt retention and volume expansion by inducing sodium and water reabsorption in the kidney. Moreover, a growing body of evidence has highlighted the detrimental consequences of "non-classical" effects of aldosterone in several target tissues. Aldosterone-induced vascular remodeling, sympathetic overactivity, insulin resistance, and adipose tissue dysfunction can further contribute to the worsening of arterial hypertension and to the development of drug-resistance. In addition, the pro-oxidative, pro-fibrotic, and pro-inflammatory effects of aldosterone may aggravate end-organ damage, thereby perpetuating a vicious cycle that eventually leads to a more severe hypertensive phenotype. Finally, neither the pathophysiological mechanisms mediating aldosterone-driven blood pressure rise, nor those mediating aldosterone-driven end-organ damage, are specifically blocked by standard first-line anti-hypertensive drugs, which might further account for the drug-resistant phenotype that frequently characterizes PA patients.
Keyphrases
- blood pressure
- angiotensin ii
- drug resistant
- adipose tissue
- end stage renal disease
- insulin resistance
- arterial hypertension
- hypertensive patients
- ejection fraction
- newly diagnosed
- oxidative stress
- prognostic factors
- chronic kidney disease
- heart rate
- multidrug resistant
- high fat diet
- gene expression
- skeletal muscle
- pseudomonas aeruginosa
- systemic sclerosis
- patient reported outcomes
- physical activity
- polycystic ovary syndrome
- stress induced