Primary
aldosteronism (PA) is one of the common forms of curable
hypertension. Recent views have suggested that PA is far from being relatively benign, as it was previously thought, but it is associated with a variety of cardiovascular and renal sequelae that reflect the capability of inappropriately elevated
aldosterone to induce tissue damage over that induced by
hypertension itself. The evidence supporting these views has been obtained from experiments conducted in hypertensive animal models and studies involving patients with PA. Preclinical studies have also indicated that
aldosterone causes cardiovascular and renal tissue damage only in the context of inappropriate
salt status. It has been suggested that untoward effects of high-
salt intake are dependent on activation of
mineralocorticoid receptors (MRs) that might result from increased oxidative stress and changes in the intracellular redox potential. Unilateral
adrenalectomy or treatment with MR antagonists are the current options for treating an
aldosterone-producing
adenoma (APA) or idiopathic adrenal
hyperplasia (IHA). Treatments are effective in correcting
hypertension and
hypokalemia, and currently available information on their capability to prevent cardiovascular events and deterioration of renal function indicates that surgery and medical treatment are equally beneficial in the long term.