Reasons why baseline plasma aldosterone concentrations may not predict the response to aldosterone blockade
| • Aldosterone acts locally in a paracrine fashion |
| • Some effects of aldosterone may occur by the fast, non-genomic route which is not blocked by traditional aldosterone receptor blockers |
| • Mineralocorticoid receptors can be stimulated by non-mineralocorticoids—for example, glucocorticoids. |
| • Some diseases decrease 11 βHSD (11β hydroxysteroid dehydrogenase) enzyme activity and hence encourage glucocorticoid stimulation of mineralocorticoid receptors |
| • Aldosterone blockade acts as neurohormonal blockers when aldosterone concentrations are high but as subtle natriuretic agents when aldosterone concentrations are low |