Mineralocorticoid receptor-associated hypertension and its organ damage

Clinical relevance for resistant hypertension

Hirotaka Shibata, Hiroshi Itoh

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

The role of aldosterone in the pathogenesis of hypertension and cardiovascular diseases has been clearly shown in congestive heart failure and endocrine hypertension due to primary aldosteronism. In resistant hypertension, defined as a failure of concomitant use of three or more different classes of antihypertensive agents to control blood pressure (BP), add-on therapy with mineralocorticoid receptor (MR) antagonists is frequently effective, which we designate as M"R-associated hypertension". The MR-associated hypertension is classified into two subtypes, that with elevated plasma aldosterone levels and that with normal plasma aldosterone levels. The former subtype includes primary aldosteronism (PA), aldosterone-associated hypertension which exhibited elevated aldosterone-to-renin ratio and plasma aldosterone levels, but no PA, aldosterone breakthrough phenomenon elicited when angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) is continued to be given, and obstructive sleep apnea. In contrast, the latter subtype includes obesity, diabetes mellitus, chronic kidney disease (CKD), and polycystic ovary syndrome (PCOS). The pathogenesis of MR-associated hypertension with normal plasma aldosterone levels is considered to be mediated by MR activation by pathways other than high aldosterone levels, such as increased MR levels, increased MR sensitivity, and MR overstimulation by other factors such as Rac1. For resistant hypertension with high plasma aldosterone levels, MR antagonist should be given as a first-line therapy, whereas for resistant hypertension with normal aldosterone levels, ARB or ACE-I should be given as a first-line therapy and MR antagonist would be given as an add-on agent.

Original languageEnglish
Pages (from-to)514-523
Number of pages10
JournalAmerican Journal of Hypertension
Volume25
Issue number5
DOIs
Publication statusPublished - 2012 May

Fingerprint

Mineralocorticoid Receptors
Aldosterone
Hypertension
Mineralocorticoid Receptor Antagonists
Hyperaldosteronism
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Polycystic Ovary Syndrome
Obstructive Sleep Apnea
Chronic Renal Insufficiency
Renin
Antihypertensive Agents
Diabetes Mellitus
Cardiovascular Diseases
Therapeutics
Heart Failure
Obesity

Keywords

  • aldosterone
  • blood pressure
  • hypertension
  • mineralocorticoid receptor
  • resistant hypertension

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Mineralocorticoid receptor-associated hypertension and its organ damage : Clinical relevance for resistant hypertension. / Shibata, Hirotaka; Itoh, Hiroshi.

In: American Journal of Hypertension, Vol. 25, No. 5, 05.2012, p. 514-523.

Research output: Contribution to journalArticle

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