Ananda Roshan A, Mori Trevor A, Yang Jun
Department of General Medicine, Box Hill Hospital, Melbourne, VIC 3128, Australia.
Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, WA 6000, Australia.
Metabolites. 2025 Aug 17;15(8):553. doi: 10.3390/metabo15080553.
Aldosterone excess, particularly in the context of primary aldosteronism, is associated with adverse cardiovascular outcomes. Historically considered a condition of resistant hypertension with hypokalaemia, patients with primary aldosteronism often experienced prolonged diagnostic delay with significant end-organ damage involving the renal, cardiovascular, and central nervous systems at diagnosis. Emerging research has revealed a wide spectrum of renin-independent aldosteronism, ranging from subclinical disease with normal or mildly elevated BP to overt disease marked by resistant hypertension and cardiovascular complications. Subclinical forms of primary aldosteronism have been identified across all age groups, and it is increasingly linked to early signs of adverse cardiac remodelling, even in young adults. Notably, adverse cardiac remodelling was independent of blood pressure. Furthermore, primary aldosteronism confers excess cardiovascular morbidity and mortality compared to blood-pressure-matched essential hypertension. Importantly, these risks can be mitigated through timely diagnosis and treatment with mineralocorticoid receptor antagonists. In this narrative review, we explore the cardiovascular consequences of aldosterone excess, discuss the pathophysiological mechanisms underlying cardiac remodelling, and examine the implications of renin-independent aldosteronism for cardiovascular risk across the lifespan.
醛固酮过多，尤其是在原发性醛固酮增多症的情况下，与不良心血管结局相关。原发性醛固酮增多症患者历史上被认为是伴有低钾血症的难治性高血压，往往诊断延迟时间长，诊断时肾脏、心血管和中枢神经系统等重要终末器官受到显著损害。新出现的研究揭示了一系列不依赖肾素的醛固酮增多症，从血压正常或轻度升高的亚临床疾病到以难治性高血压和心血管并发症为特征的显性疾病。原发性醛固酮增多症的亚临床形式在所有年龄组中均有发现，甚至在年轻人中也越来越多地与不良心脏重塑的早期迹象相关。值得注意的是，不良心脏重塑与血压无关。此外，与血压匹配的原发性高血压相比，原发性醛固酮增多症会导致更多的心血管发病率和死亡率。重要的是，通过及时诊断并用盐皮质激素受体拮抗剂治疗，这些风险可以得到缓解。在这篇叙述性综述中，我们探讨醛固酮过多对心血管的影响，讨论心脏重塑的病理生理机制，并研究不依赖肾素的醛固酮增多症对全生命周期心血管风险的影响。
