Pleiotropic Actions of Aldosterone and the Effects of Eplerenone, a Selective Mineralocorticoid Receptor Antagonist

Aldosterone plays an important role in the pathogenesis of cardiovascular and renal disease that is independent of angiotensin II. Mineralocorticoid receptors are expressed in nonepithelial tissues such as the heart and blood vessels. Although mineralocorticoid receptor antagonism reduces mortality in patients with congestive heart failure, the progestational and antiandrogenic side effects of the nonspecific mineralocorticoid receptor antagonist, spironolactone, have limited its usefulness in the treatment of cardiovascular diseases. This review examines the expanding role of aldosterone, including its broad spectrum of non-classical effects, and the recent clinical and experimental trials with the selective mineralocorticoid receptor antagonist, eplerenone.