Salt, the renin-angiotensin-aldosterone system and resistant hypertension

High salt intake is a risk for developing resistant hypertension, and even under triple therapy with diuretics, an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and a calcium channel blocker, the volume is occasionally not controlled. In such cases, a mineralocorticoid receptor (MR) antagonist additively lowers the circulating blood volume and blood pressure despite the lower circulating aldosterone level. This mechanism may be explained by the increase in the number of MR under some conditions or the activation of these receptors independent of aldosterone. Future diagnostic tools to evaluate receptor activity may be valuable for the proper diagnosis and choice of therapy. Additionally, basic research has suggested that oxidative stress and the renin-angiotensin-aldosterone system in the brain represent new targets for the treatment of resistant hypertension.