High blood pressure is one of the world’s most common health problems. It often develops without clear symptoms, yet over time it can damage blood vessels and raise the risk of heart attack, stroke, kidney disease and other serious conditions.
Scientists at Brigham and Women’s Hospital found that a hormone called aldosterone may play a much bigger role in high blood pressure than doctors once believed. Their findings suggest that many people may have an overlooked hormonal cause behind their condition.
Aldosterone is made by the adrenal glands, two small glands located above the kidneys. The hormone helps the body control salt and water, which makes it important for keeping blood pressure within a healthy range.
Problems can develop when the body produces too much aldosterone. The kidneys may hold on to extra salt, and water follows that salt, increasing the amount of fluid in the bloodstream and pushing blood pressure higher.
Doctors call excessive aldosterone production primary aldosteronism. For many years, it was often considered an uncommon cause of high blood pressure, so testing has generally been focused on selected patients, such as those with severe or difficult-to-control hypertension.
The researchers wanted to find out whether excess aldosterone might actually be more widespread. They studied people across a range of blood pressure levels, including people with normal blood pressure and those with mild, moderate or more severe hypertension.
A clear pattern appeared in the results. As blood pressure became more severe, excess aldosterone production became increasingly common, suggesting that the condition may exist across a broad range rather than simply being present or absent.
Many people with abnormal aldosterone production would also have been missed by commonly used screening methods. This is important because patients whose high blood pressure is partly driven by aldosterone may benefit from treatments that directly target the hormone’s effects.
Primary aldosteronism is especially important because it is not simply another way of developing high blood pressure. Research has linked excessive aldosterone with greater risks of heart and blood vessel damage, meaning that identifying the condition could help doctors better understand a patient’s long-term risk.
There are already medicines that can block the effects of aldosterone. Drugs such as spironolactone and eplerenone are used in medical care and can help some patients lower their blood pressure by reducing the harmful effects of excess aldosterone.
Some patients have excess hormone production coming mainly from one adrenal gland. In selected cases, doctors can use additional testing to identify the source, and surgery to remove the affected adrenal gland may provide a more targeted treatment.
The new findings do not mean that aldosterone is responsible for every case of hypertension. High blood pressure can have many causes and is influenced by factors such as age, genetics, body weight, diet, physical activity, kidney health and other medical conditions.
However, the study challenges the traditional idea that primary aldosteronism is rare. The researchers argue that doctors may need to think of excess aldosterone as a more common part of high blood pressure and consider whether current testing methods are missing many patients.
Earlier recognition could matter because high blood pressure affects more than a billion people worldwide and is a major preventable cause of early illness and death. Even modest improvements in diagnosis and treatment could therefore benefit a very large number of people.
The research was led by Dr. Jenifer M. Brown of Brigham and Women’s Hospital and colleagues and was published in the journal Annals of Internal Medicine. The findings add to growing evidence that excessive aldosterone production may be an underrecognized contributor to high blood pressure and deserves greater attention in future research and clinical care.
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