Aldosterone, the key
hormone in the
mineralocorticoid pathway, plays a fundamental role in
salt and water homeostasis, blood pressure regulation, and cardiovascular remodeling. Both genomic and nongenomic mechanisms influence
aldosterone-induced renal
sodium reabsorption. Furthermore, the
mineralocorticoid receptors in nonepithelial tissues, including the heart and vascular smooth muscle cells, have recently been discovered. Thus,
aldosterone likely has pleiotropic effects that contribute to the modulation of blood pressure. Among patients with
hypertension in general, and among those with more severe or resistant
hypertension in particular, a higher-than-expected prevalence of
primary hyperaldosteronism is noted. Among individuals with resistant
hypertension,
aldosterone antagonists have also been shown to be effective in lowering blood pressure. Most significantly, recent community-based studies among non-hypertensive individuals in the general population have demonstrated that both higher serum
aldosterone concentrations and a higher
aldosterone to
renin ratio portend a greater risk of developing
hypertension. The combination of the aforementioned observations underscores the importance of the
mineralocorticoid pathway in the pathogenesis of
hypertension.