The renin-angiotensin-aldosterone system - new pathogenetic and therapeutic aspects Part 2. Aldosterone - important inductor of pathogenetic pathways damaging the cardiovascular system and kidneys

Abstract

Participation of aldosterone in the pathogenesis of vascular fibrosis, glomerulosclerosis, progression of different glomerulopathies and heart muscle remodelling in hypertensive patients has already been proven, both in clinical and experimental studies. This fact was the reason why aldosterone antagonists or blockers of mineralocorticosteroid receptors (MR) became important drugs used in prevention or/and treatment of cardiovascular injuries in hypertensive patients and in patients with chronic renal glomerulopathies. Most of the damaging effects of aldosterone are induced by stimulation of the MRs and expression of the MDM2 gene (genomic pathway), by stimulation of proinflammatory cytokines and by generation of reactive oxygen species - ROS (nongenomic pathway). These injuring effects of aldosterone can be prevented or attenuated by using specific or nonspecific aldosterone antagonists. Therapeutic benefits of aldosterone treatment have already been proven in patients with diabetic nephropathy and other glomerulopathies, in postacute myocardial infarction patients and in patients with active atherosclerotic vascular lesions. Thus aldosterone antagonists seem to be important components of contemporary therapeutic strategies used in hypertensive patients and patients with kidney diseases. Arterial Hypertension 2007, vol. 11, no 4, pages 357-363.