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2014 ; 34
(5
): 532-9
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Pathophysiology and treatment of resistant hypertension: the role of aldosterone
and amiloride-sensitive sodium channels
#MMPMID25416662
Judd EK
; Calhoun DA
; Warnock DG
Semin Nephrol
2014[]; 34
(5
): 532-9
PMID25416662
show ga
Resistant hypertension is a clinically distinct subgroup of hypertension defined
by the failure to achieve blood pressure control on optimal dosing of at least 3
antihypertensive medications of different classes, including a diuretic. The
pathophysiology of hypertension can be attributed to aldosterone excess in more
than 20% of patients with resistant hypertension. Existing dogma attributes the
increase in blood pressure seen with increases in aldosterone to its
antinatriuretic effects in the distal nephron. However, emerging research, which
has identified and has begun to define the function of amiloride-sensitive sodium
channels and mineralocorticoid receptors in the systemic vasculature, challenges
impaired natriuresis as the sole cause of aldosterone-mediated resistant
hypertension. This review integrates these findings to better define the role of
the vasculature and aldosterone in the pathophysiology of resistant hypertension.
In addition, a brief guide to the treatment of resistant hypertension is
presented.