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

 

作者: Pitt Lim,   Allan Struthers,   Thomas MacDonald,  

 

期刊: Journal of Hypertension  (OVID Available online 2002)
卷期: Volume 20, issue 1  

页码: 11-15

 

ISSN:0263-6352

 

年代: 2002

 

出版商: OVID

 

关键词: primary aldosteronism;essential hypertension;aldosterone to renin ratio

 

数据来源: OVID

 

摘要:

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.

 

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