Mineralocorticoid receptor-associated hypertension and target organ damage: Clinical relevance for resistant hypertension in end stage renal disease

Yelena Rekhtman, Andrew S. Bomback

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Mineralocorticoid receptor (MR) blockade has proven efficacy in the treatment of hypertension and in improving morbidity and mortality in patients with heart failure. The potential importance of mineralocorticoid receptor blockade has grown recently amid the observation that angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers do not effectively reduce aldosterone levels in all patients over the long term. To date, research on the role of MR blockade has primarily focused on resistant hypertension, decreasing proteinuria, and potentially preventing disease progression in early stages of chronic kidney disease (CKD). Given the prevalence of co-morbid resistant hypertension and cardiovascular disease in patients with end-stage renal disease (ESRD), however, interest in the role of MR blockade in this patient population has arisen. In this paper, we review the current evidence for using MR blockade in mild-tomoderate and resistant hypertension in patients with normal renal function, CKD, and ESRD. We discuss recent animal and human studies on the role of aldosterone in mediating hypertension as well as vascular and tissue damage. We then review clinical studies on the use of MR blockade in ameliorating aldosterone's deleterious end organ effects and its applicability to patients with ESRD. Finally, we summarize the evidence to date supporting the safety of MR blockade in patients with ESRD.

Original languageEnglish (US)
Pages (from-to)267-275
Number of pages9
JournalCurrent Hypertension Reviews
Volume8
Issue number4
DOIs
StatePublished - 2012
Externally publishedYes

Fingerprint

Mineralocorticoid Receptors
Chronic Kidney Failure
Hypertension
Aldosterone
Chronic Renal Insufficiency
Angiotensin Receptor Antagonists
Proteinuria
Angiotensin-Converting Enzyme Inhibitors
Blood Vessels
Disease Progression
Cardiovascular Diseases
Heart Failure
Morbidity
Kidney
Safety
Mortality
Research
Population

Keywords

  • Aldosterone
  • End organ damage
  • End stage renal disease
  • Hyperkalemia
  • Mineralocorticoid receptor blockade
  • Resistant hypertension

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Mineralocorticoid receptor-associated hypertension and target organ damage : Clinical relevance for resistant hypertension in end stage renal disease. / Rekhtman, Yelena; Bomback, Andrew S.

In: Current Hypertension Reviews, Vol. 8, No. 4, 2012, p. 267-275.

Research output: Contribution to journalArticle

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