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The Mechanisms of Actions of Aldosterone and its Antagonists in Cardiovascular Disease

[ Vol. 24 , Issue. 46 ]

Author(s):

Panteleimon Pantelidis, Michail Sideris, Margus Viigimaa, Konstantinos Avranas, Pavlos Deligkaris, Ioanna Zografou and Dragan Lovic*   Pages 5491 - 5499 ( 9 )

Abstract:


Background: Aldosterone, through its actions on Mineralcorticosteroid Receptors (MR), controls fluid and electrolyte balance, but also exerts various direct deleterious actions on the vasculature. A number of aldosterone antagonists have been manufactured to reverse these effects.

Objective: A comprehensive review of the underlying mechanisms of the actions of aldosterone and its antagonists in cardiovascular disease.

Method: The relevant studies indexed in PubMed, Scopus and Google Scholar databases, published from 2003 to May 2018 were identified and reported.

Results: Aldosterone binds to MR, activating them as intracellular transcription factors. Moreover, aldosterone, through its actions on MR, as well as on another not fully explored class of receptors, triggers several signaling pathways that produce rapid, non-genomic actions. In the vasculature, all these changes favor the establishment of inflammation and cardiovascular dysfunction, which, in turn, lead to or exacerbate various cardiovascular diseases. Mineralcorticosteroid Antagonists (MRA) are compounds that antagonize the action of aldosterone on MR. Spironolactone was the first steroidal MRA to be commercially used. It showed beneficial clinical results, but also a number of adverse effects. The next generation of steroidal MRA, exhibited lower potency but did not induce many of these adverse reactions, due to their high selectivity for MR. The third generation of MRA compromises the newly introduced non-steroidal MRA, which have a completely different chemical structure, they induce different and more drastic changes to MR, they are much more specific and currently under clinical trials.

Conclusion: New MRA, which block the aldosterone induced pathways in the vasculature, hold promising results for the treatment of cardiovascular disease.

Keywords:

Aldosterone, mineralocorticoid antagonists, cardiovascular disease, spironolactone, eplerenone, non-steroidal MRAs, Steroidal MRAs.

Affiliation:

2nd Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Women Health Research Unit, Queen Mary University of London, London, Centre of Cardiology, North Estonia Medical Centre, Tallinn, Estonia; Institute of Health Technologies, Tallinn University of Technology, Tallinn, 2nd Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, 2nd Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, 2nd Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Clinic for Internal Disease Intermedica, Cardiology department, Hypertension Center, Nis



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