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The purposes of the research were to study the prevalence of C-344T polymorphism and the distribution of aldosterone synthase gene (CYP11B2) genotypes, to analyze the association of aldosterone concentration with aldosterone synthase gene genotypes, to study the features of left ventricular hypertrophy (LVH) by echocardioscopy and identify their association with different genotypes of the aldosterone synthase gene in young patients with arterial hypertension (AH), depending on the presence or absence of concomitant obesity (or overweight). 123 young patients with essential AH (18-44 years old) were examined, the average age was (32,83±0,58) years old, the male/female ratio was 72/51 respectively. All patients were divided into 3 groups: group 1 (n=41) with normal body weight; group 2 (n=40) with overweight; group 3 (n=42) -with obesity. It was revealed that the "pathological" genotypes (CC+CT) of the aldosterone synthase gene C-344T polymorphism were significantly more frequent in patients as with normal body weight and with concomitant obesity or overweight. In concomitant overweight and obesity the average blood aldosterone concentration was significantly higher, that confirms the presence of additional activation of aldosterone synthesis in such comorbid combination and requires further study of the exact mechanism of this type of hyperaldosteronism. Concomitant overweight and obesity significantly influenced on the echocardiographic parameters characterizing LVH processes in young patients with AH with the significant increased proportion of eccentric LVH. "Pathological" genotypes (CT+TT) of the C-344T polymorphism of the aldosterone synthase gene are associated with a higher blood aldosterone concentration and more expressed LVH processes in young patients with AH.
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Rev Cardiovasc Med
August 2025
Department of Emergency Medicine, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, 610041 Chengdu, Sichuan, China.
Background: Compared to patients with controllable hypertension, those with resistant hypertension (RH) have a higher incidence of cardiovascular complications, including stroke, left ventricular hypertrophy, and congestive heart failure. Therefore, an urgent need exists for improved management and control, along with more effective medications. Aldosterone synthase inhibitors (ASIs) are newly emerging drugs that have gradually attracted an increasing amount of attention.
View Article and Find Full Text PDFJ Mol Endocrinol
September 2025
INSERM, UMRS 1166, Hôpital La Pitié Salpetriere, Sorbonne Université, Paris, France.
Aldosterone is synthesized by the CYP11B2 enzyme, primarily in the zona glomerulosa of the adrenal gland. It exerts its classical effects on sodium and water balance in the renal distal nephron through binding to the mineralocorticoid receptor (MR). Excess aldosterone production or overactivation of the MR outside the distal nephron leads to cardiac, renal, and vascular injury by increasing oxidative stress and activating the inflammatory and fibrotic pathways.
View Article and Find Full Text PDFCard Fail Rev
August 2025
Temerty Faculty of Medicine, University of Toronto, Toronto Ontario, Canada.
The renin-angiotensin-aldosterone system is integral to cardiorenal health, with aldosterone controlling fluid balance, blood pressure and cardiac remodelling. Despite the widespread use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and mineralocorticoid receptor antagonists, 'aldosterone escape' persists, contributing to treatment failure and adverse outcomes. Steroidal mineralocorticoid receptor antagonists also cause hyperkalaemia and anti-androgenic effects, limiting their use.
View Article and Find Full Text PDFN Engl J Med
August 2025
University College London Institute of Cardiovascular Science and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London.
Background: Aldosterone dysregulation plays an important pathogenic role in hard-to-control hypertension. In several studies, baxdrostat, an aldosterone synthase inhibitor, reduced the seated systolic blood pressure of patients with uncontrolled or resistant hypertension.
Methods: In this phase 3, multinational, double-blind, randomized, placebo-controlled trial, we recruited patients with a seated systolic blood pressure of between 140 mm Hg and less than 170 mm Hg despite the receipt of stable treatment with two antihypertensive medications (uncontrolled hypertension) or three or more such medications (resistant hypertension), including a diuretic.
N Engl J Med
August 2025
Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom.