| Sign In to gain access to subscriptions and/or personal tools. |
Mineralocorticoid receptor blockade: new insights into the mechanism of action in patients with cardiovascular diseaseDivision of Cardiology, The University of Michigan, USA, bpitt{at}umich.edu
Department of Pharmacology, New York Medical College, USA
Division of Cardiology, The University of Michigan, USA Mineralocorticoid receptor (MR) blockade is effective in reducing total mortality and the incidence of heart failure in patients with systolic left ventricular dysfunction (SLVD) associated with chronic heart failure or post myocardial infarction. Pre-clinical and clinical studies in SLVD have shown that MR blockade reduces sudden cardiac death, left ventricular remodelling, left ventricular hypertrophy, endothelial dysfunction, autonomic imbalance, renal dysfunction and improves fibrinolysis. While MR blockade promotes sodium excretion and the combination of an angiotensin-converting enzyme inhibitor and a MR blocker have been shown to be more effective than either alone in causing natriuresis, it is unlikely that their beneficial effects can be explained solely on this basis.
Aldosterone has been shown to have a number of adverse effects, including activation of other neurohumeral mediators, stimulation of active reactive oxygen species (ROS), activation of the NF- In view of these mechanisms, MR blockade may play an important role not only on SLVD, but also in essential hypertension with normal systolic function, diastolic heart failure, valvular heart disease, vascular stiffening with ageing, progression of renal disease, and diabetes mellitus. This hypothesis will, however, require further prospective evaluation.
Key Words: aldosterone • cortisol • systolic left ventricular dysfunction • heart failure • myocardial infarction
Journal of Renin-Angiotensin-Aldosterone System, Vol. 4, No. 3,
164-168 (2003) This article has been cited by other articles:
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 |
|
|
 |
Sign In to gain access to subscriptions and/or personal tools.
β and AP-1 signalling pathways, vascular inflammation and fibrosis, myocardial hypertrophy, autonomic imbalance, and a decrease in fibrinolysis. MR blockade is, however, effective both in situations with and without an increase in serum aldosterone level, since the MR can be occupied and activated by cortisol as well as by aldosterone. 
