Copyright © 1995 by the European Society of Cardiology.
© 1995 The European Society of Cardiology
Aldosterone and heart failure
Departments of Cardiology and Clinical Pharmacology, University Henri Poincaré, Hôpital Central Nancy, France
Correspondence: Dr Faicz Zannad, Centre d'Investigation (CIC.INSERM-CHU), Cardiologie, Hôpital Central, 54000 Nancy, France.
In untreated congestive heart failure, aldosterone plasma concentrations are elevated in proportion to the severity of the disease and are further increased by the use of diuretic treatment. Angiotensin II, plasma potassium concentrations, and corticotropin are the major stimulators of aldosterone synthesis. During angiotensin converting enzyme (ACE) inhibition, the role of alternative major or minor regulatory mechanisms may become significant. This may explain why during continuous ACE inhibition, after an initial reduction, plasma aldosterone measurements may subsequently increase to pretherapeutic levels. In addition to causing sodium and water retention, aldosterone contributes to hypokalaemia and hypomagnesaemia, which may induce electrical instability and death of cardiac myocytes. Aldosterone is also one factor involved in cardiac hypertrophy and fibrosis, which, together with myocardial cell death, may underlie progressive adverse myocardial remodelling. Evidence for a direct vascular effect of aldosterone suggests that this hormone may contribute to generalized vasoconstriction. Elevated plasma aldosterone levels can also contribute to depression of barorefiex sensitivity, and they are associated with increased mortality in patients with severe heart failure. Experimental and clinical research should be further expanded to investigate the potential benefits of opposing the effects of aldosterone by use of specific antagonists or other potentially more potent pharmacological agents with favourable side-effect profiles.
Key Words: Aldosterone • heart failure • spironolactone • renin-angiotensin-aldosterone system • myocardial remodelling
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