Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0007222 (cardiovascular disease)
 65,817 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Blockade of a mineralocorticoid receptor is a clinically useful approach to the prevention of cardiovascular disease. The present study was designed to evaluate the effect of azelnidipine, a unique dihydropyridine Ca(2+) channel blocker, on aldosterone production in the human adrenocortical cell line NCI-H295R. Azelnidipine inhibited angiotensin II- and KCl-induced expression of steroid 11beta-hydroxylase, steroid 18-hydroxylase, and the alpha1H subunit of the T-type Ca(2+) channel, and suppressed steroid biosynthesis in H295R cells by the same amount as efonidipine. On the basis of these findings, azelnidipine appears to suppress steroid biosynthesis in H295R cells beyond the blockade of L-type calcium channels.
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PMID:Azelnidipine inhibits aldosterone synthesis and secretion in human adrenocortical cell line NCI-H295R. 1916 55

Aldosterone plays an important pathophysiological role in cardiovascular disease, and aldosterone (mineralocorticoid) receptor antagonism has been used in the treatment of heart failure and hypertension. However, aldosterone receptor antagonism is associated with an increase in plasma aldosterone levels, which may result in non-mineralocorticoid receptor-mediated (non-genomic) adverse effects. Therefore, the inhibition of aldosterone synthesis may be preferable to blockade at the receptor level. Direct inhibitors of aldosterone synthase are currently under development. However, specificity for aldosterone synthase remains a challenge, and the search for more potent and more selective compounds is ongoing. Experimental animal and human studies are required to establish whether aldosterone synthase inhibitors will be successful as therapeutic agents.
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PMID:Aldosterone synthase inhibitors: pharmacological and clinical aspects. 1933 52

Chronic heart failure (CHF) is associated with frequent hospitalizations and high mortality. It affects more than 5 million individuals in the USA, and another 660,000 new cases are diagnosed each year; overall, heart failure (HF) now accounts for 7% of all deaths from cardiovascular disease. Hypertension (HTN) increases the risk of development of HF and it precedes it in 75% of cases. HF patients are nearly evenly divided between those with reduced left ventricular (LV) function or systolic dysfunction and those with preserved LV systolic function or diastolic dysfunction. The management of HTN in patients with CHF is challenging. Drugs such as beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone receptor blockers, hydralazine and nitrates, which have shown mortality benefit in CHF and exert antihypertensive effects, should be used as first-line agents to control HTN in CHF. In addition, antihypertensive drugs such as alpha-receptor blockers that can increase mortality in HF should be avoided. The dihydropyridine group of calcium channel blockers are good antihypertensive medications with a neutral effect on mortality in patients with CHF. These may be used in CHF patients with refractory HTN. In patients with HF with reduced ejection fraction, HTN is treated differently in comparison to patients with HF with normal ejection fraction. This article reviews the treatment of essential HTN in patients at risk for developing HF, in the presence of HF and the latest developments in treatment that might benefit both HTN and HF management.
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PMID:Management of hypertension in chronic heart failure. 1937 66

Certain patient populations have a high prevalence of hypertension, including black, elderly, or obese patients; patients with metabolic syndrome, or frank diabetes; and patients with chronic kidney disease. Many of these patients experience renin-angiotensin-aldosterone system (RAAS) dysregulation, which is important because the RAAS plays a pivotal role in the pathogenesis of hypertension, cardiovascular disease, and renal dysfunction. Data available regarding newer approaches that target the RAAS, including direct renin inhibition and aldosterone receptor antagonism, in patients who often have hypertension are reviewed. Aliskiren, the first direct renin inhibitor, is effective in a number of these patient groups, including those who are black or obese or who have metabolic syndrome, renal impairment, or diabetes. In addition, in the setting of long-term angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, aldosterone receptor antagonists (spironolactone and eplerenone) provide another rational therapeutic approach for patients whose blood pressure is not controlled by standard therapies.
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PMID:New therapeutic options in patients prone to hypertension: a focus on direct Renin inhibition and aldosterone blockade. 1939 Apr 29

The prevalence of obesity, diabetes, hypertension, and cardiovascular and chronic kidney disease is increasing in developed countries. Obesity, insulin resistance, and hypertension commonly cluster with other risk factors for cardiovascular and chronic kidney disease to form the metabolic syndrome. Emerging evidence supports a paradigm shift in our understanding of the renin-angiotensin-aldosterone system and in aldosterone's ability to promote insulin resistance and participate in the pathogenesis of the metabolic syndrome and resistant hypertension. Recent data suggest that excess circulating aldosterone promotes the development of both disorders by impairing insulin metabolic signaling and endothelial function, which in turn leads to insulin resistance and cardiovascular and renal structural and functional abnormalities. Indeed, hyperaldosteronism is associated with impaired pancreatic beta-cell function, skeletal muscle insulin sensitivity, and elevated production of proinflammatory adipokines from adipose tissue, which results in systemic inflammation and impaired glucose tolerance. Accumulating evidence indicates that the cardiovascular and renal abnormalities associated with insulin resistance are mediated in part by aldosterone acting on the mineralocorticoid receptor. Although we have known that mineralocorticoid receptor blockade attenuates cardiovascular and renal injury, only recently have we learned that mineralocorticoid receptor blockade improves pancreatic insulin release, insulin-mediated glucose utilization, and endothelium-dependent vasorelaxation. In summary, aldosterone excess has detrimental metabolic effects that contribute to the metabolic syndrome and endothelial dysfunction, which in turn contribute to the development of resistant hypertension as well as cardiovascular disease and chronic kidney disease.
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PMID:Narrative review: the emerging clinical implications of the role of aldosterone in the metabolic syndrome and resistant hypertension. 1948 12

The mineralocorticoid receptor (MR) plays a central role in electrolyte homeostasis and in cardiovascular disease. We have previously reported a ligand-dependent N/C-interaction in the MR. In the present study we sought to fully characterize the MR N/C-interaction. By using a range of natural and synthetic MR ligands in a mammalian two-hybrid assay we demonstrate that in contrast to aldosterone, which strongly induces the interaction, the physiological ligands deoxycorticosterone and cortisol weakly promote the interaction but predominantly inhibit the aldosterone-mediated N/C-interaction. Similarly, progesterone and dexamethasone antagonize the interaction. In contrast, the synthetic agonist 9alpha-fludrocortisol robustly induces the interaction. The ability of the N/C interaction to discriminate between MR agonists suggests a subtle conformational difference in the ligand-binding domain induced by these agonists. We also demonstrate that the N/C interaction is not cell specific, consistent with the evidence from a glutathione-S-transferase pull-down assay, of a direct protein-protein interaction between the N- and C-terminal domains of the MR. Examination of a panel of deletions in the N terminus suggests that several regions may be critical to the N/C-interaction. These studies have identified functional differences between physiological MR ligands, which suggest that the ligand-specific dependence of the N/C-interaction may contribute to the differential activation of the MR that has been reported in vivo.
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PMID:Structural and functional characterization of the interdomain interaction in the mineralocorticoid receptor. 1954 44

Appreciation for the role of aldosterone and mineralocorticoid receptors in cardiovascular disease is accelerating rapidly. Recent experimental work has unveiled a strong relationship between brain mineralocorticoid receptors and sympathetic drive, an important determinant of outcome in heart failure and hypertension. Two putative mechanisms are explored in this manuscript. First, brain mineralocorticoid receptors may influence sympathetic discharge by regulating the release of pro-inflammatory cytokines into the circulation. Blood-borne pro-inflammatory cytokines act upon receptors in the microvasculature of the brain to induce cyclooxygenase-2 activity and the production of prostaglandin E(2), which penetrates the blood-brain barrier to activate the sympathetic nervous system. Second, brain mineralocorticoid receptors may influence sympathetic drive by upregulating the activity of the brain renin-angiotensin system, resulting in NAD(P)H oxidase-dependent superoxide production. A potential role for superoxide-dependent mitogen-activated protein kinase signalling pathways in the regulation of sympathetic nerve activity is also considered. Other potential downstream signalling mechanisms contributing to mineralocorticoid receptor-mediated sympathetic excitation are under investigation.
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PMID:Mineralocorticoid receptors, inflammation and sympathetic drive in a rat model of systolic heart failure. 2006 26

Chronic stress causes elevations in glucocorticoid secretion and also increases the incidence of hypertension and other manifestations of cardiovascular disease. The extent to which the elevated glucocorticoids mediate the stress-associated increase in cardiovascular disease risk is unknown. Chronically elevated glucocorticoids can cause hypertension by acting in the periphery, but their effects within the brain on blood pressure regulation remain largely unexplored. We developed a method to produce selective chronic increases in the endogenous glucocorticoid corticosterone or the glucocorticoid receptor antagonist mifepristone within the hindbrain region, which includes a key cardiovascular regulatory area, the nucleus of the solitary tract (NTS). Experiments were performed in male Sprague-Dawley, Wistar-Kyoto (WKY) and borderline hypertensive rats (BHR). The results indicate that elevated exogenous corticosterone can act within the hindbrain to enhance the arterial pressure response to novel restraint stress and to reduce the gain and increase the mid-point of the arterial baroreflex. Basal levels of endogenous corticosterone have no effect on the arterial pressure response to stress in normotensive rats but enhance this response in BHR. Chronic stress-induced increases in baseline corticosterone enhance the arterial pressure response to stress in BHR but attenuate the adaptation of the response in WKY rats. Furthermore, an elevated corticosterone concentration within the hindbrain is necessary but not sufficient to cause glucocorticoid-induced hypertension. The effects of corticosterone within the hindbrain on blood pressure regulation are mediated in part by the glucocortiocid receptor, but are also likely to involve mineralocorticoid receptor-mediated effects and NTS catecholaminergic neurons. These data support the hypothesis that elevated glucocorticoids acting within the brain probably contribute to the adverse effects of stress on cardiovascular health in susceptible people.
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PMID:Regulation of the stress response in rats by central actions of glucocorticoids. 2006 26

Recent interest in mineralocorticoid receptor (MR) antagonism in cardiovascular disease reflects recognition that blockade of the renin-angiotensin system may be followed by a breakthrough in aldosterone levels to or above the normal range. The Randomized Aldactone Evaluation Study (RALES) trial in progressive heart failure, Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) in post-infarct heart failure, and the 4E trial in essential hypertension demonstrated the efficacy of MR blockade in addition to standard therapy. In all three trials, plasma aldosterone levels were low and sodium status unremarkable; this finding, and those of various preclinical studies, point squarely at pathophysiological MR activation by ligands other than aldosterone, most likely normal levels of cortisol, and provide clear evidence for the therapeutic utility of MR blockade in conditions of tissue and organ damage with normal aldosterone levels.
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PMID:Eplerenone: hypertension, heart failure and the importance of mineralocorticoid receptor blockade. 1980 89

Excessive production of aldosterone leads to the development of hypertension and cardiovascular disease by generating an inflammatory state that can be promoted by T cell immunity. Because nature and intensity of T cell responses is controlled by dendritic cells (DCs), it is important to evaluate whether the function of these cells can be modulated by aldosterone. In this study we show that aldosterone augmented the activation of CD8(+) T cells in a DC-dependent fashion. Consistently, the mineralocorticoid receptor was expressed by DCs, which showed activation of MAPK pathway and secreted IL-6 and TGF-beta in response to aldosterone. In addition, DCs stimulated with aldosterone impose a Th17 phenotype to CD4(+) T cells, which have recently been associated with the promotion of inflammatory and autoimmune diseases. Accordingly, we observed that aldosterone enhances the progression of experimental autoimmune encephalomyelitis, an autoimmune disease promoted by Th17 cells. In addition, blockade of the mineralocorticoid receptor prevented all aldosterone effects on DCs and attenuated experimental autoimmune encephalomyelitis development in aldosterone-treated mice. Our data suggest that modulation of DC function by aldosterone enhances CD8(+) T cell activation and promotes Th17-polarized immune responses, which might contribute to the inflammatory damage leading to hypertension and cardiovascular disease.
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PMID:Aldosterone promotes autoimmune damage by enhancing Th17-mediated immunity. 1994 98


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