Nicolás Federico: Aldosterone Dysregulation as a Driver of Cardiorenal Disease
Nicolás Federico, Fellow of the International Society of Hypertension, Adjunct Professor of Medicine at the National University of Cuyo, and Head of the Hypertension Unit at Hospital Español de Mendoza, shared a post on LinkedIn։
՛՛Aldosterone dysregulation as a driver of cardiorenal disease
A recent narrative review published in Current Heart Failure Reports (Erzeel et al., 2026) revisits the evolution of mineralocorticoid pathway modulation across heart failure and chronic kidney disease, shifting the focus from drugs to pathophysiology.
Rather than viewing aldosterone merely as a volume-regulating hormone, growing evidence supports its role in a broader maladaptive phenotype characterized by:
- sodium retention and volume expansion
- vascular inflammation and fibrosis
- cardiac remodeling and hypertrophy
- renal injury and albuminuria
- sympathetic overactivation
From a mechanistic perspective, different therapeutic strategies act at distinct levels of the aldosterone pathway:
Mineralocorticoid receptor antagonists (steroidal and non-steroidal) primarily block downstream tissue effects.
Emerging aldosterone synthase inhibitors aim to suppress upstream aldosterone production, potentially preventing hormonal breakthrough.
This framework highlights an important concept:
aldosterone dysregulation may define different cardiorenal phenotypes, each requiring a tailored therapeutic approach.
Importantly, this pathophysiological view may also help interpret heterogeneity in treatment response across hypertension, heart failure, and chronic kidney disease populations.
As outcome trials continue to mature, understanding where and how we intervene along this pathway will be central to precision cardiorenal medicine.՛՛
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