ABSTRACT

Over the last 40 years, numerous clinical and experimental studies have demonstrated that blockade of the renin-angiotensin-aldosterone system (RAAS) with either angiotensin converting enzyme (ACE) inhibitors or angiotensin (Ang) II receptor antagonists provides significant cardiovascular protection. More recently, a growing body of evidence has indicated that pharmacological antagonism of aldosterone, the third component of this neurohormonal axis, also provides significant incremental benefit against the deleterious consequences of abnormal activation of this system on cardiovascular tissues. In the present chapter, we examine the most relevant clinical and experimental evidence around the pathophysiologic role for aldosterone in the development of cardiovascular disease. Specifically, we discuss the relative roles of the classic epithelial effects versus the novel nonepithelial effects of this steroid that lead to the development of hypertension and related complications such as renal disease and congestive heart failure.