Impact of aldosterone on vascular pathophysiology

The fact that spironolactone reduces deaths in cardiac failure suggests that aldosterone promotes cardiac death in heart failure, which begs the question: What are the mechanisms whereby it does this? The mechanisms whereby aldosterone promotes cardiac death are likely to be a combination of its production of endothelial dysfunction, myocardial fibrosis, and autonomic imbalance. It is quite possible that all three of these mechanisms actually stem from aldosterone's adverse effects on the endothelium. The term "aldosterone vasculopathy" has been coined to describe that the fundamentally adverse effect of aldosterone may well be on endothelial nitric oxide.