Aldosterone in vascular and metabolic dysfunction

Abstract

Purpose of review This review will highlight recent developments in mineralocorticoid receptor research which impact aldosterone-associated vascular and cardio-metabolic dysfunction. Recent findings The mineralocorticoid receptor is also expressed in vascular smooth muscle and vascular endothelium, and contribute to vascular function and remodeling. Adipocyte-derived leptin stimulates aldosterone secretion, which may explain the observed link between obesity and hyperaldosteronism. Adipocyte mineralocorticoid receptor overexpression produces systemic changes consistent with metabolic syndrome. Ongoing studies with novel nonsteroidal mineralocorticoid receptor antagonists may provide a novel treatment for diabetic nephropathy and heart failure in subjects with chronic kidney disease with reduced risk of hyperkalemia. Summary Ongoing research continues to demonstrate novel roles of the vascular and adipocyte mineralocorticoid receptor function, which may explain the beneficial metabolic and vascular benefits of mineralocorticoid receptor antagonists.

Aldosterone is involved in the pathogenesis of obesity-related glomerulopathy through activation of Wnt/β-catenin signaling in podocytes

“…Obese patients (16,(35)(36)(37) and obese rats (12) often exhibit elevated levels of circulating ALDO. Adipocytes are able to produce a number of ALDO-releasing substances, which stimulate adrenal ALDO secretion independently of angiotensin Ⅱ (4,11,16,(39)(40)(41)(42). In addition, adipocytes themselves are able to synthesize and secrete ALDO (39,43).…”

“…In addition, adipocytes themselves are able to synthesize and secrete ALDO (39,43). Previous studies have demonstrated that both circulating ALDO and adipocyte-derived ALDO participate in the development of obesity-related hypertension and cardiovascular complications (39,40,42,43). Therefore, the present study conducted a preliminary exploration into whether ALDO participated in ORG pathogenesis.…”

Editorial Comment to Implication of aortic calcification on persistent hypertension after laparoscopic adrenalectomy in patients with primary aldosteronism

“…Aortic calcification might also be caused as a result of severe and prolonged HT. However, according to recent reports, aldosterone has a direct effect on vascular endothelium and vascular smooth muscle independently of blood pressure, and can promote vascular calcification . Therefore, patients with PA potentially have aortic calcification more frequently than those with essential HT.…”

“…However, as a matter of course, there should not be any hesitation to carry out an adrenalectomy, even in such patients. Recent evidence shows that aldosterone directly affects cardiac muscle, renal tissue and the metabolism . Needless to say, an adrenalectomy can improve hypokalemia.…”

“…Recent evidence shows that aldosterone directly affects cardiac muscle, renal tissue 1,4 and the metabolism. 1 Needless to say, an adrenalectomy can improve hypokalemia. In addition, the prevention and improvement of damage in cardiac and vascular tissues, kidney disease, and metabolic disorder can be expected from an adrenalectomy.…”