CHRONIC MINERALOCORTICOID EXCESS AND CARDIOVASCULAR REMODELING

Chronic mineralocorticoid (MC) excess, whether due to elevated plasma aldosterone (ALDO) or deoxycorticosterone (DOC), is associated with a perivascular fibrosis of systemic and coronary arterioles. This remode ling of resistance vessels contributes to the appearance of hypertensi on. Chronic MC excess is also accompanied by cardiac myocyte necrosis, secondary to myocardial potassium depletion, and a subsequent reparat ive fibrosis that appears in the normotensive, nonhypertrophied right and hypertensive, hypertrophied left ventricles. Fibrosis contributes to the appearance of ventricular arrhythmias and dysfunction. Herein, clinical and experimental evidence linking chronic, inappropriate (rel ative to dietary sodium) elevations in circulating ALDO and DOC with t hese reactive and reparative forms of fibrous tissue formation in the heart and other tissues is presented.