Janmohamed Salim, Bouloux Pierre-Marc G
Department of Endocrinology, Royal Free Hospital, London, NW3 2QG, UK.
Expert Opin Pharmacother. 2006 Apr;7(5):563-73. doi: 10.1517/14656566.7.5.563.
Aldosterone is increasingly considered to have a fundamental role in the pathophysiology of cardiovascular disease. Primary aldosteronism is a much more common cause of secondary hypertension than once suspected, accounting for approximately 10% of cases. Screening for primary aldosteronism should be considered even in the presence of normokalaemia. The non-classical effects of aldosterone, some of which are transcription-independent, may be of similar or greater importance than its traditional effects on the kidney. Treatment of primary aldosteronism should be specific and aim to ameliorate all hormone-related effects of aldosterone, not just the most obvious manifestation of hypertension. Mineralocorticoid antagonism, shown to lead to significant additional survival advantage in heart failure, offers the best prospect for achieving therapeutic goals. For the increasing proportion of patients with primary aldosteronism suitable for long-term medical treatment, mineralocorticoid receptor blockade (better tolerated with eplerenone) should be considered the most appropriate choice of treatment, pending the development of better alternatives.
醛固酮在心血管疾病的病理生理学中日益被认为具有重要作用。原发性醛固酮增多症是继发性高血压比以往所怀疑的更为常见的病因，约占病例的10%。即使血钾正常，也应考虑对原发性醛固酮增多症进行筛查。醛固酮的非经典作用，其中一些是不依赖转录的，可能与其对肾脏的传统作用具有相似或更大的重要性。原发性醛固酮增多症的治疗应具有特异性，旨在改善醛固酮所有与激素相关的作用，而不仅仅是最明显的高血压表现。盐皮质激素拮抗作用已被证明可在心力衰竭中带来显著的额外生存优势，为实现治疗目标提供了最佳前景。对于越来越多适合长期药物治疗的原发性醛固酮增多症患者，在有更好的替代药物出现之前，应考虑盐皮质激素受体阻断（依普利酮耐受性更好）是最恰当的治疗选择。
