The neurohormonal natural history of essential hypertension: towards primary or tertiary aldosteronism?

Abstract:

:Use of the aldosterone-to-renin ratio has controversially suggested that approximately 10% of hypertensives have primary aldosteronism, and most of these individuals are thought to have idiopathic hyperaldosteronism. The usual renin-angiotensin system control is intact in these individuals and is similar to that in low renin and essential hypertensives, differing only in the degree of sensitivity. There is recent evidence suggesting that hyperaldosteronism relates to aldosterone synthase genetic polymorphism, and also that increased angiotensin II stimulation of the adrenal glands appears to paradoxically upregulate the receptors increasing angiotensin II sensitivity. Taken together, the possibility arises that, in susceptible hypertensives, hyperaldosteronism could be acquired. Indeed, it is well known that renin-driven renovascular hypertension is associated with the development of hyperaldosteronism. Hypothetically, within the wider hypertensive population, these findings set the scene that angiotensin II adrenal sensitivity increases over time until the secretion of aldosterone becomes "autonomous" and hence "tertiary" aldosteronism in a significant proportion of hypertensives.

journal_name

J Hypertens

journal_title

Journal of hypertension

authors

Lim PO,Struthers AD,MacDonald TM

doi

10.1097/00004872-200201000-00003

subject

Has Abstract

pub_date

2002-01-01 00:00:00

pages

11-5

issue

1

eissn

0263-6352

issn

1473-5598

journal_volume

20

pub_type

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