Abstract-Aldosteronism eventuates in a proinflammatory/fibrogenic vascular phenotype of the heart and systemic organs.It remains uncertain whether peripheral blood mononuclear cells (PBMCs) are activated before tissue invasion by monocytes/macrophages and lymphocytes, as is the case for responsible pathogenic mechanisms. Uninephrectomized rats treated for 4 weeks with dietary 1% NaCl and aldosterone (ALDOST, 0.75 g/h) with or without spironolactone (Spi, 100 mg/kg per daily gavage) were compared with unoperated/untreated and uninephrectomized/salt-treated controls. Before intramural coronary vascular lesions appeared at week 4 of ALDOST, we found (1) a reduction of PBMC cytosolic free [Mg 2ϩ ] i , together with intracellular Mg 2ϩ and Ca 2ϩ loading, whereas plasma and cardiac tissue Mg 2ϩ were no different from controls; (2) increased H 2 O 2 production by monocytes and lymphocytes together with upregulated PBMC gene expression of oxidative stress-inducible tyrosine phosphatase and Mn 2ϩ -superoxide dismutase and the presence of 3-nitrotyrosine in CD4ϩ and ED-1-positive inflammatory cells that had invaded intramural coronary arteries; (3) B-cell activation, including transcription of immunoglobulins, intracellular adhesion molecule-1, and CC and CXC chemokines and their receptors; (4) expansion of B lymphocyte subset and myosin heavy chain class II-expressing lymphocytes; and (5) autoreactivity with gene expression for antibodies to acetylcholine receptors and a downregulation of RT-6.2, which is in keeping with cell activation and associated with autoimmunity. Spi cotreatment attenuated the rise in intracellular Ca 2ϩ , the appearance of oxidative/nitrosative stress in PBMCs and invading inflammatory cells, and alterations in PBMC transcriptome. Thus, aldosteronism is associated with an activation of circulating immune cells induced by iterations in PBMC divalent cations and transduced by oxidative/nitrosative stress. ALDO receptor antagonism modulates this neuroendocrine-immune interface. The full text of this article is available online at http://www.circresaha.org. (Circ Res. 2003;93:e124-e135.) Key Words: aldosterone Ⅲ peripheral blood mononuclear cells Ⅲ hydrogen peroxide production Ⅲ cytosolic free Mg 2ϩ and Ca 2ϩ Ⅲ transcriptome I rrespective of its etiologic origins, asymptomatic ventricular systolic dysfunction eventuates in an activation of the circulating renin-angiotensin-aldosterone system (RAAS), whose effector hormones contribute to the appearance of the congestive heart failure (CHF) syndrome. A chronic systemic illness ensues that features oxidative/nitrosative stress in such diverse tissues as skeletal muscle, peripheral blood mononuclear cells (PBMCs) (monocytes and lymphocytes), and heart 1-11 ; elevated circulating levels of proinflammatory cytokines and chemokines [12][13][14][15][16][17][18][19][20][21] ; and a wasting syndrome that eventuates in cachexia. 22 Pharmacological modulation of RAAS effector hormones has proven clinical benefits in patients with CHF. [23][24][25][26][27] A ro...