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The Ubiquitous Mineralocorticoid Receptor: Clinical Implications

Current Hypertension Reports volume 14, pages 573–580 (2012)Cite this article

Abstract

Mineralocorticoid receptors (MR) exist in many tissues, in which they mediate diverse functions crucial to normal physiology, including tissue repair and electrolyte and fluid homeostasis. However, inappropriate activation of MR within these tissues, and especially in the brain, causes hypertension and pathological vascular, cardiac, and renal remodeling. MR binds aldosterone, cortisol and corticosterone with equal affinity. In aldosterone-target cells, co-expression with the 11β-hydroxysteroid dehydrogenase 2 (HSD2) allows aldosterone specifically to activate MR. Aldosterone levels are excessive in primary aldosteronism, but in conditions with increased oxidative stress, like CHF, obesity and diabetes, MR may also be inappropriately activated by glucocorticoids. Unlike thiazide diuretics, MR antagonists are diuretics that do not cause insulin resistance. Addition of MR antagonists to standard treatment for hypertension and cardiac or renal disease decreases end-organ pathology and sympathetic nerve activation (SNA), and increases quality of life indices.

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Affiliations

  1. Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, 1500 E. Woodrow Wilson Dr., Jackson, MS, 39216, USA

    Urseline A. Hawkins, Elise P. Gomez-Sanchez & Celso E. Gomez-Sanchez

  2. Division of Endocrinology, Department of Medicine, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, 39216, USA

    Urseline A. Hawkins, Elise P. Gomez-Sanchez, Clara M. Gomez-Sanchez & Celso E. Gomez-Sanchez

  3. Department of Pharmacology and Toxicology, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, 39216, USA

    Elise P. Gomez-Sanchez

  4. Clinical Fellow in Endocrinology, Division of Endocrinology, Department of Medicine, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, 39216, USA

    Urseline A. Hawkins

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  1. Urseline A. Hawkins
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Hawkins, U.A., Gomez-Sanchez, E.P., Gomez-Sanchez, C.M. et al. The Ubiquitous Mineralocorticoid Receptor: Clinical Implications. Curr Hypertens Rep 14, 573–580 (2012). https://doi.org/10.1007/s11906-012-0297-0

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Keywords

  • Hypertension
  • Blood pressure
  • Aldosterone
  • Mineralocorticoid receptor
  • (MR)
  • Glucocorticoids
  • Thiazides
  • Thiazide diuretics
  • Congestive heart failure
  • CHF
  • Primary aldosteronism
  • Obesity
  • Diabetes mellitus
  • Diabetic nephropathy
  • Cardiac fibrosis
  • Metabolic syndrome
  • Sympathetic nerve activation
  • Hyperkalemia