T he corticosteroid hormones cortisol and aldosterone are important determinants of blood pressure and cardiovascular risk. Excess cortisol results in Cushing syndrome, associated with hypertension and accelerated atherogenesis, 1 whereas excess aldosterone, in primary aldosteronism, leads to severe hypertension with markedly increased risk of myocardial infarction, stroke, and left ventricular hypertrophy. 2 The frequency of primary aldosteronism in hypertensive patients is now accepted to be ≈5% to 10% 3,4 ; recent studies show that aldosterone is an important predictor of cardiovascular risk and outcome, with levels toward the high end of the normal range predicting blood pressure and development of hypertension. 5 Controlled release of corticosteroids from the adrenal cortex is achieved, in part, by strictly regulated expression of genes encoding the steroidogenic enzymes that catalyze their biosynthetic pathways. The final enzymes in this process are particularly important: 11β-hydroxylase (CYP11B1) is responsible for the terminal conversion that produces cortisol, whereas aldosterone synthase (CYP11B2) fulfills the equivalent role in aldosterone production. The CYP11B1 and CYP11B2 genes lie in tandem on human chromosome 8 and have ≈93% sequence similarity within their coding regions. 6 Changes in the expression of these genes have been observed in cases of aldosterone-producing adenoma (APA). 7,8 In addition, the rate of aldosterone production is known to be heritable, 9 and several polymorphisms in the CYP11B1 and CYP11B2 genes associate with altered 11β-hydroxylation, aldosterone production, or hypertension. 10 Although it is relatively straightforward to propose mechanisms by which polymorphisms in the 5′ regulatory regions of these genes, such as rs1799998, 11 could affect transcription, it is not immediately apparent how polymorphisms located in introns or the 3′ untranslated region (3′ UTR) of these genes could alter expression. However, in recent years, microRNAs (miRNAs) have emerged as key regulatory molecules that regulate ≈30% of human genes.12 They are endogenous, single-stranded noncoding RNA molecules of ≈22 nucleotides, produced through a series of maturation reactions mediated by the RNase III enzymes, Drosha and Dicer.13 These post-transcriptional regulatory molecules exert their effects by targeting the 3′ UTR of specific mRNAs. Through mRNA destabilization Abstract-Dysregulation of aldosterone or cortisol production can predispose to hypertension, as seen in aldosteroneproducing adenoma, a form of primary aldosteronism. We investigated the role of microRNA (miRNA) in their production, with particular emphasis on the CYP11B1 (11β-hydroxylase) and CYP11B2 (aldosterone synthase) genes, which produce the enzymes responsible for the final stages of cortisol and aldosterone biosynthesis, respectively. Knockdown of Dicer1, a key enzyme in miRNA maturation, significantly altered CYP11B1 and CYP11B2 expression in a human adrenocortical cell line. Screening of nondiseased human adrenal and aldost...