Abstract

Aldosterone is a vitally important factor in cardiovascular homeostasis. Tightly regulated control of the biosynthesis and action of this mineralocorticoid hormone are crucial given that its excessive secretion, as seen in primary aldosteronism (PA), can result in severe hypertension, extensive organ damage and various comorbidities. The individual and societal consequences of this are huge: PA is currently held to account for ~15% of all hypertensive patients, but, due to difficulties in its accurate diagnosis, even this figure is likely to be an underestimate. Many patients are therefore currently classified as essential hypertensives and are receiving suboptimal treatment. Greater understanding of the regulatory systems governing aldosterone biosynthesis and action is therefore likely to be of huge benefit, leading to improved diagnostics, identification of informative biomarkers and development of better treatments more accurately targeted at the sizeable subsection of hypertensive patients most likely to benefit. In this article we describe the major factors governing aldosterone biosynthesis and action in normal physiology and disease while also summarising significant recent advances in our understanding of PA and other promising current areas of research. It is our intention that this will provide insights into the highly dynamic state of current aldosterone research and the very real potential for game-changing treatments to counter the causes and consequences of excess aldosterone in the near future.