Aldosterone blockade in cardiovascular disease

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Abstract
The first novel finding discovered about aldosterone is that it is made locally in various different tissues in the body including the brain, vascular tissue, and the myocardium.1, 2 In heart failure, myocardial tissue synthesises even more aldosterone. The second novel finding is that mineralocorticoid receptors which are activated by aldosterone are in fact also widespread in the body including the brain, vascular tissue, and the myocardium. This means that aldosterone may act in a paracrine fashion in many tissues—that is, locally made aldosterone may act on local aldosterone receptors to mediate local (mostly adverse) effects. This may be one of many reasons why baseline plasma aldosterone values appear to only poorly predict the efficacy of aldosterone blockade. Other reasons may also explain this (see below and table 2).

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