Aldosterone and cardiovascular pathology: from bench to bedside

Thirty years ago, aldosterone was an unidimensional hormone considered responsible for salt and water homeostasis. The current role of aldosterone in pathology is very complex. Recognition of mineralocorticoid receptors throughout the body has raised the importance of aldosterone in understanding the pathophysiology of previously unknown cardiovascular effects. This came from the first documentation of aldosterone receptors outside the kidney, making it not only an endocrine hormone, but a paracrine one, too. Aldosterone is contemporary appreciated to play an important role as a cardiac and vascular risk hormone. Aldosterone-mediated actions include the expression of several genes: collagen genes; genes controlling tissue growth factors and plasminogen activator inhibitor type 1; genes mediating inflammation. Aldosterone receptor blocking agents improve cardiovascular structure, function, and prognosis. They appear to provide additive benefit when used in conjunction with either an ACE inhibitor or an angiotensin receptor blocker.