Skip Navigation

Cardiovascular Research 2004 61(4):663-670; doi:10.1016/j.cardiores.2003.11.037
© 2004 by European Society of Cardiology
This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Struthers, A. D
Right arrow Articles by MacDonald, T. M
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Struthers, A. D
Right arrow Articles by MacDonald, T. M
Social Bookmarking
 Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Copyright © 2004, European Society of Cardiology

Review of aldosterone- and angiotensin II-induced target organ damage and prevention

Allan D Struthers* and Thomas M MacDonald

Department of Clinical Pharmacology and Therapeutics, Ninewells Hospital and Medical School, Tayside DD1 9SY, Dundee, UK

* Corresponding author. Tel.: +44-1382-632574; fax: +44-1382-644972. a.d.struthers{at}dundee.ac.uk

Aldosterone is well recognized as a cause of sodium reabsorption, water retention, and potassium and magnesium loss; however, it also produces a variety of other actions that lead to progressive target organ damage in the heart, vasculature, and kidneys. Aldosterone interacts with mineralocorticoid receptors to promote endothelial dysfunction, facilitate thrombosis, reduce vascular compliance, impair baroreceptor function, and cause myocardial and vascular fibrosis. Although angiotensin II has been considered the major mediator of cardiovascular damage, increasing evidence suggests that aldosterone may mediate and exacerbate the damaging effects of angiotensin II. While angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers reduce plasma aldosterone levels initially, aldosterone rebound, or ‘escape’ may occur during long-term therapy. Therefore, aldosterone blockade is required to reduce the risk of progressive target organ damage in patients with hypertension and heart failure. This may be achieved nonselectively with spironolactone or with use of the selective aldosterone blocker eplerenone. While both agents have been demonstrated to be effective antihypertensive agents, eplerenone may produce improved target organ protection as witnessed in a variety of clinical settings, without the antiandrogenic and progestational effects commonly observed with spironolactone.

KEYWORDS Heart failure; Target organ damage; Aldosterone; Angiotensin II; Spironolactone; Eplerenone


Time for primary review 20 days


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
HypertensionHome page
T. Nakamura, K. Kataoka, M. Fukuda, H. Nako, Y. Tokutomi, Y.-F. Dong, H. Ichijo, H. Ogawa, and S. Kim-Mitsuyama
Critical Role of Apoptosis Signal-Regulating Kinase 1 in Aldosterone/Salt-Induced Cardiac Inflammation and Fibrosis
Hypertension, September 1, 2009; 54(3): 544 - 551.
[Abstract] [Full Text] [PDF]


Home page
HypertensionHome page
J. M. A. Delou, A. G. Lopes, and M. A.M. Capella
Unveiling the Role of Multidrug Resistance Proteins in Hypertension
Hypertension, August 1, 2009; 54(2): 210 - 216.
[Full Text] [PDF]


Home page
Exp PhysiolHome page
B. Martin-Fernandez, M.ķa Miana, N. De las Heras, G. Ruiz-Hurtado, M.ķa Fernandez-Velasco, M. Bas, S. Ballesteros, V. Lahera, V. Cachofeiro, and C. Delgado
Cardiac L-type calcium current is increased in a model of hyperaldosteronism in the rat
Exp Physiol, June 1, 2009; 94(6): 675 - 683.
[Abstract] [Full Text] [PDF]


Home page
Nephrol Dial TransplantHome page
W. Fang, D. G. Oreopoulos, and J. M. Bargman
Use of ACE inhibitors or angiotensin receptor blockers and survival in patients on peritoneal dialysis
Nephrol. Dial. Transplant., November 1, 2008; 23(11): 3704 - 3710.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
B. Pitt
The measurement of plasma aldosterone in patients post-myocardial infarction
Eur. Heart J., October 2, 2008; 29(20): 2451 - 2452.
[Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
A.C. Montezano, G.E. Callera, A. Yogi, Y. He, R.C. Tostes, G. He, E.L. Schiffrin, and R.M. Touyz
Aldosterone and Angiotensin II Synergistically Stimulate Migration in Vascular Smooth Muscle Cells Through c-Src-Regulated Redox-Sensitive RhoA Pathways
Arterioscler Thromb Vasc Biol, August 1, 2008; 28(8): 1511 - 1518.
[Abstract] [Full Text] [PDF]


Home page
HypertensionHome page
R. Fischer, R. Dechend, F. Qadri, M. Markovic, S. Feldt, F. Herse, J.-K. Park, A. Gapelyuk, I. Schwarz, U. B. Zacharzowsky, et al.
Dietary n-3 Polyunsaturated Fatty Acids and Direct Renin Inhibition Improve Electrical Remodeling in a Model of High Human Renin Hypertension
Hypertension, February 1, 2008; 51(2): 540 - 546.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
N. Henke, R. Schmidt-Ullrich, R. Dechend, J.-K. Park, F. Qadri, M. Wellner, M. Obst, V. Gross, R. Dietz, F. C. Luft, et al.
Vascular Endothelial Cell Specific NF-{kappa}B Suppression Attenuates Hypertension-Induced Renal Damage
Circ. Res., August 3, 2007; 101(3): 268 - 276.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
P. Collins, G. Rosano, C. Casey, C. Daly, M. Gambacciani, P. Hadji, R. Kaaja, T. Mikkola, S. Palacios, R. Preston, et al.
Management of cardiovascular risk in the peri-menopausal woman: a consensus statement of European cardiologists and gynaecologists
Eur. Heart J., August 2, 2007; 28(16): 2028 - 2040.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
R. Fischer, R. Dechend, A. Gapelyuk, E. Shagdarsuren, K. Gruner, A. Gruner, P. Gratze, F. Qadri, M. Wellner, A. Fiebeler, et al.
Angiotensin II-induced sudden arrhythmic death and electrical remodeling
Am J Physiol Heart Circ Physiol, August 1, 2007; 293(2): H1242 - H1253.
[Abstract] [Full Text] [PDF]


Home page
EndocrinologyHome page
K. Inagaki, F. Otsuka, J. Suzuki, Y. Kano, M. Takeda, T. Miyoshi, H. Otani, Y. Mimura, T. Ogura, and H. Makino
Involvement of Bone Morphogenetic Protein-6 in Differential Regulation of Aldosterone Production by Angiotensin II and Potassium in Human Adrenocortical Cells
Endocrinology, June 1, 2006; 147(6): 2681 - 2689.
[Abstract] [Full Text] [PDF]


Home page
Mol. Endocrinol.Home page
L. Hunyady and K. J. Catt
Pleiotropic AT1 Receptor Signaling Pathways Mediating Physiological and Pathogenic Actions of Angiotensin II
Mol. Endocrinol., May 1, 2006; 20(5): 953 - 970.
[Abstract] [Full Text] [PDF]


Home page
EndocrinologyHome page
S. J. Buss, J. Backs, M. M. Kreusser, S. E. Hardt, C. Maser-Gluth, H. A. Katus, and M. Haass
Spironolactone Preserves Cardiac Norepinephrine Reuptake in Salt-Sensitive Dahl Rats
Endocrinology, May 1, 2006; 147(5): 2526 - 2534.
[Abstract] [Full Text] [PDF]


Home page
Nephrol Dial TransplantHome page
A. Covic, P. Gusbeth-Tatomir, and D. J. A. Goldsmith
Is it time for spironolactone therapy in dialysis patients?
Nephrol. Dial. Transplant., April 1, 2006; 21(4): 854 - 858.
[Full Text] [PDF]


Home page
Journal of Renin-Angiotensin-Aldosterone SystemHome page
N. C Shah, S. Pringle, and A. Struthers
Aldosterone Blockade Over and Above ACE-Inhibitors in Patients with Coronary Artery Disease but without Heart Failure
Journal of Renin-Angiotensin-Aldosterone System, March 1, 2006; 7(1): 20 - 30.
[Abstract] [PDF]


Home page
Mayo Clin Proc.Home page
W. H. W. Tang, A. C. Parameswaran, A. P. Maroo, and G. S. Francis
Aldosterone Receptor Antagonists in the Medical Management of Chronic Heart Failure
Mayo Clin. Proc., December 1, 2005; 80(12): 1623 - 1630.
[Abstract] [PDF]


Home page
Eur Heart JHome page
R. M.A. van de Wal, D. J. van Veldhuisen, W. H. van Gilst, and A. A. Voors
Addition of an angiotensin receptor blocker to full-dose ACE-inhibition: controversial or common sense?
Eur. Heart J., November 2, 2005; 26(22): 2361 - 2367.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
L.-J. Min, M. Mogi, J.-M. Li, J. Iwanami, M. Iwai, and M. Horiuchi
Aldosterone and Angiotensin II Synergistically Induce Mitogenic Response in Vascular Smooth Muscle Cells
Circ. Res., September 2, 2005; 97(5): 434 - 442.
[Abstract] [Full Text] [PDF]


Home page
Cardiovasc ResHome page
D. Fraccarollo, P. Galuppo, I. Schmidt, G. Ertl, and J. Bauersachs
Additive amelioration of left ventricular remodeling and molecular alterations by combined aldosterone and angiotensin receptor blockade after myocardial infarction
Cardiovasc Res, July 1, 2005; 67(1): 97 - 105.
[Abstract] [Full Text] [PDF]


Home page
HypertensionHome page
J. Blanco-Rivero, V. Cachofeiro, V. Lahera, R. Aras-Lopez, I. Marquez-Rodas, M. Salaices, F. E. Xavier, M. Ferrer, and G. Balfagon
Participation of Prostacyclin in Endothelial Dysfunction Induced by Aldosterone in Normotensive and Hypertensive Rats
Hypertension, July 1, 2005; 46(1): 107 - 112.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
G. S. Francis and W.H. W. Tang
Should we consider aldosterone as the primary screening target for preventing cardiovascular events?
J. Am. Coll. Cardiol., April 19, 2005; 45(8): 1249 - 1250.
[Full Text] [PDF]


Home page
Eur Heart JHome page
P. Agostoni, A. Magini, D. Andreini, M. Contini, A. Apostolo, M. Bussotti, G. Cattadori, and P. Palermo
Spironolactone improves lung diffusion in chronic heart failure
Eur. Heart J., January 2, 2005; 26(2): 159 - 164.
[Abstract] [Full Text] [PDF]


Home page
Cardiovasc ResHome page
D. Garcia-Dorado, K.-D. Schluter, E. A. Martinson, and H. M. Piper
Which papers are most interesting to the readers of Cardiovascular Research? Information from download monitoring
Cardiovasc Res, January 1, 2005; 65(1): 1 - 5.
[Full Text] [PDF]


Home page
NEJMHome page
F. J. Haddy, R. Kleta, K. O'Brien, A. A. Syed, C. P.F. Redfern, J. U. Weaver, R. S. Vasan, E. J. Benjamin, D. Levy, R. G. Dluhy, et al.
Aldosterone Revisited
N. Engl. J. Med., November 11, 2004; 351(20): 2131 - 2133.
[Full Text] [PDF]


Home page
CirculationHome page
A. Garnier, J. K. Bendall, S. Fuchs, B. Escoubet, F. Rochais, J. Hoerter, J. Nehme, M.-L. Ambroisine, N. De Angelis, G. Morineau, et al.
Cardiac Specific Increase in Aldosterone Production Induces Coronary Dysfunction in Aldosterone Synthase-Transgenic Mice
Circulation, September 28, 2004; 110(13): 1819 - 1825.
[Abstract] [Full Text] [PDF]


Home page
HypertensionHome page
J. Diez
Profibrotic Effects of Angiotensin II in the Heart: A Matter of Mediators
Hypertension, June 1, 2004; 43(6): 1164 - 1165.
[Full Text] [PDF]



Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.