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Aldosterone and arterial hypertension

Nature Reviews Endocrinology volume 6, pages 83–93 (2010)Cite this article

Abstract

In the setting of primary aldosteronism, elevated aldosterone levels are associated with increased blood pressure. Aldosterone concentrations within the normal range, however, can also alter blood pressure. Furthermore, the aldosterone-to-renin ratio, an indicator of aldosterone excess, is associated with hypertension, even in patients without excessive absolute aldosterone levels. In this Review we assess the data on the role of aldosterone in the development and maintenance of hypertension. We provide an overview of the complex crosstalk between genetic and environmental factors, and about aldosterone-mediated arterial hypertension and target organ damage. The discussion is organized according to major targets of aldosterone action: the collecting duct in the kidney, the vasculature and the central nervous system. The antihypertensive efficacy of mineralocorticoid-receptor blockers, even in patients with aldosterone values in the normal range, supports the evidence that aldosterone plays a part in blood pressure elevation in the absence of primary aldosteronism.

Key Points

  • Clinical and experimental evidence shows that aldosterone makes a major contribution beyond primary aldosteronism to the pathogenesis of arterial hypertension

  • Aldosterone excess contributes to endothelial dysfunction, inflammation and vascular remodeling, which result in the development and maintenance of arterial hypertension, via genomic and nongenomic pathways

  • Aldosterone-mediated effects on epithelial and nonepithelial tissues depend on mineralocorticoid sensitivity, which is modulated by salt and angiotensin II

  • Renal Na+ and fluid retention, endothelial dysfunction, increased peripheral resistance and central sympathetic drive are major pathogenic pathways of aldosterone-induced arterial hypertension

  • Mineralocorticoid-receptor blockers are useful drugs to treat aldosterone-mediated arterial hypertension, especially when other antihypertensive drugs insufficiently control blood pressure

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Figure 1: The renin–angiotensin–aldosterone system.
Figure 2: Mechanisms of aldosterone-mediated arterial hypertension.

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Acknowledgements

A. Tomaschitz and S. Pilz have contributed equally in drafting the initial version of this article.

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  1. Division of Endocrinology and Nuclear Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria

    Andreas Tomaschitz, Stefan Pilz, Barbara Obermayer-Pietsch & Thomas R. Pieber

  2. Division of Nephrology, Kidney Center, Ruperto Carola University of Heidelberg, Im Neuenheimer Feld 162, Heidelberg, 69120, Germany

    Eberhard Ritz

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Tomaschitz, A., Pilz, S., Ritz, E. et al. Aldosterone and arterial hypertension. Nat Rev Endocrinol 6, 83–93 (2010). https://doi.org/10.1038/nrendo.2009.263

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