Hypertension and the expanding role of aldosterone.

Aldosterone is the principal human mineralocorticoid and plays a significant role in hypertension and cardiovascular morbidity. Classically, aldosterone is synthesized in the adrenal zona glomerulosa and binds to mineralocorticoid receptors in the cytosol of target epithelial cells. Nonepithelial and rapid nongenomic actions of aldosterone have now also been described, as well as a number of extra-adrenal sites of synthesis, including the central nervous system. Recent studies also suggest that elevated aldosterone biosynthesis, as defined by an increased aldosterone-to-renin ratio, is present in up to 15% of essential hypertensives and that aldosterone levels predict the development of hypertension in normotensive individuals. Furthermore, mineralocorticoid-receptor antagonists demonstrate that aldosterone is a significant contributor to cardiovascular pathology. In this article, we present the evidence behind these findings and explore the expanding role of aldosterone as a key cardiovascular hormone.