{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T02:57:04Z","timestamp":1791255424072,"version":"4.1.0"},"reference-count":94,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,2,14]],"date-time":"2022-02-14T00:00:00Z","timestamp":1644796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Primary aldosteronism (PA) is the most common cause of secondary hypertension. A growing body of evidence has suggested that, beyond its well-known effects on blood pressure and electrolyte balance, aldosterone excess can exert pro-inflammatory, pro-oxidant and pro-fibrotic effects on the kidney, blood vessels and heart, leading to potentially harmful pathophysiological consequences. In clinical studies, PA has been associated with an increased risk of cardiovascular, cerebrovascular, renal and metabolic complication compared to essential hypertension, including atrial fibrillation (AF) and aortic ectasia. An increased prevalence of AF in patients with PA has been demonstrated in several clinical studies. Aldosterone excess seems to be involved in the pathogenesis of AF by inducing cardiac structural and electrical remodeling that in turn predisposes to arrhythmogenicity. The association between PA and aortic ectasia is less established, but several studies have demonstrated an effect of aldosterone on aortic stiffness, vascular smooth muscle cells and media composition that, in turn, might lead to an increased risk of aortic dilation and dissection. In this review, we focus on the current evidence regarding the potential role of aldosterone excess in the pathogenesis of AF and aortic ectasia.<\/jats:p>","DOI":"10.3390\/ijms23042111","type":"journal-article","created":{"date-parts":[[2022,2,14]],"date-time":"2022-02-14T20:26:42Z","timestamp":1644870402000},"page":"2111","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Atrial Fibrillation and Aortic Ectasia as Complications of Primary Aldosteronism: Focus on Pathophysiological Aspects"],"prefix":"10.3390","volume":"23","author":[{"given":"Martina","family":"Bollati","sequence":"first","affiliation":[{"name":"Endocrinology, Diabetes and Metabolism, City of Health and Science University Hospital, Department of Medical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Lopez","sequence":"additional","affiliation":[{"name":"Endocrinology, Diabetes and Metabolism, City of Health and Science University Hospital, Department of Medical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7550-7023","authenticated-orcid":false,"given":"Fabio","family":"Bioletto","sequence":"additional","affiliation":[{"name":"Endocrinology, Diabetes and Metabolism, City of Health and Science University Hospital, Department of Medical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Ponzetto","sequence":"additional","affiliation":[{"name":"Endocrinology, Diabetes and Metabolism, City of Health and Science University Hospital, Department of Medical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezio","family":"Ghigo","sequence":"additional","affiliation":[{"name":"Endocrinology, Diabetes and Metabolism, City of Health and Science University Hospital, Department of Medical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Maccario","sequence":"additional","affiliation":[{"name":"Endocrinology, Diabetes and Metabolism, City of Health and Science University Hospital, Department of Medical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6930-7073","authenticated-orcid":false,"given":"Mirko","family":"Parasiliti-Caprino","sequence":"additional","affiliation":[{"name":"Endocrinology, Diabetes and Metabolism, City of Health and Science University Hospital, Department of Medical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1210\/jc.2015-4061","article-title":"The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline","volume":"101","author":"Funder","year":"2016","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"100029","DOI":"10.1016\/j.ijchy.2020.100029","article-title":"The 2020 Italian Society of Arterial Hypertension (SIIA) practical guidelines for the management of primary aldosteronism","volume":"5","author":"Rossi","year":"2020","journal-title":"Int. J. Cardiol. Hypertens."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2293","DOI":"10.1016\/j.jacc.2006.07.059","article-title":"A Prospective Study of the Prevalence of Primary Aldosteronism in 1125 Hypertensive Patients","volume":"48","author":"Rossi","year":"2006","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1016\/j.jacc.2017.01.052","article-title":"Prevalence and Clinical Manifestations of Primary Aldosteronism Encountered in Primary Care Practice","volume":"69","author":"Monticone","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"10","DOI":"10.7326\/M20-0065","article-title":"The Unrecognized Prevalence of Primary Aldosteronism: A Cross-sectional Study","volume":"173","author":"Brown","year":"2020","journal-title":"Ann. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1097\/HJH.0000000000002441","article-title":"Prevalence of primary aldosteronism and association with cardiovascular complications in patients with resistant and refractory hypertension","volume":"38","author":"Lopez","year":"2020","journal-title":"J. Hypertens."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1159\/000345243","article-title":"Vascular actions of aldosterone","volume":"50","author":"Briet","year":"2013","journal-title":"J. Vasc. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/S2213-8587(17)30319-4","article-title":"Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: A systematic review and meta-analysis","volume":"6","author":"Monticone","year":"2018","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/HJH.0000000000002216","article-title":"Renal damage in primary aldosteronism: A systematic review and meta-analysis","volume":"38","author":"Monticone","year":"2020","journal-title":"J. Hypertens."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/S2213-8587(17)30135-3","article-title":"Outcomes after adrenalectomy for unilateral primary aldosteronism: An international consensus on outcome measures and analysis of remission rates in an international cohort","volume":"5","author":"Williams","year":"2017","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1161\/HYPERTENSIONAHA.113.01316","article-title":"Long-term control of arterial hypertension and regression of left ventricular hypertrophy with treatment of primary aldosteronism","volume":"62","author":"Rossi","year":"2013","journal-title":"Hypertension"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1001\/archinternmed.2007.33","article-title":"Cardiovascular outcomes in patients with primary aldosteronism after treatment","volume":"168","author":"Catena","year":"2008","journal-title":"Arch. Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"32103","DOI":"10.1038\/srep32103","article-title":"Long term outcome of Aldosteronism after target treatments","volume":"6","author":"Wu","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S2213-8587(17)30367-4","article-title":"Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: A retrospective cohort study","volume":"6","author":"Hundemer","year":"2018","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1161\/HYPERTENSIONAHA.118.11568","article-title":"Renal Outcomes in Medically and Surgically Treated Primary Aldosteronism","volume":"72","author":"Hundemer","year":"2018","journal-title":"Hypertension"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1161\/CIRCRESAHA.117.309732","article-title":"Atrial Fibrillation: Epidemiology, Pathophysiology, Clinical Outcomes","volume":"120","author":"Staerk","year":"2017","journal-title":"Circ. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1016\/S0002-9149(01)01905-1","article-title":"Effect of successful electrical cardioversion on serum aldosterone in patients with persistent atrial fibrillation","volume":"88","author":"Goette","year":"2001","journal-title":"Am. J. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1111\/j.1540-8159.2009.02673.x","article-title":"A decrease in serum aldosterone level is associated with maintenance of sinus rhythm after successful cardioversion of atrial fibrillation","volume":"33","author":"Bartkowiak","year":"2010","journal-title":"PACE Pacing Clin. Electrophysiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1016\/j.jacc.2005.01.015","article-title":"Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism","volume":"45","author":"Milliez","year":"2005","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1055\/s-0043-119220","article-title":"Aldosterone to Renin Ratio as a Screening Instrument for Primary Aldosteronism in a Middle-Aged Population with Atrial Fibrillation","volume":"49","author":"Mourtzinis","year":"2017","journal-title":"Horm. Metab. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1177\/2047487318759853","article-title":"Primary aldosteronism and thyroid disorders in atrial fibrillation: A Swedish nationwide case\u2013control study","volume":"25","author":"Mourtzinis","year":"2018","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1097\/HJH.0000000000002250","article-title":"Atrial fibrillation as presenting sign of primary aldosteronism: Results of the Prospective Appraisal on the Prevalence of Primary Aldosteronism in Hypertensive (PAPPHY) Study","volume":"38","author":"Seccia","year":"2020","journal-title":"J. Hypertens."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1093\/europace\/euv366","article-title":"Mineralocorticoid receptor antagonists and atrial fibrillation: A meta-analysis","volume":"18","author":"Liu","year":"2016","journal-title":"Europace"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.ijcard.2016.12.029","article-title":"Aldosterone Pathway Blockade to Prevent Atrial Fibrillation: A Systematic Review and Meta-Analysis","volume":"231","author":"Neefs","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e013267","DOI":"10.1161\/JAHA.119.013267","article-title":"Effects of Mineralocorticoid Receptor Antagonists on Atrial Fibrillation Occurrence: A Systematic Review, Meta-Analysis, and Meta-Regression to Identify Modifying Factors","volume":"8","author":"Alexandre","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1161\/HYPERTENSIONAHA.117.10596","article-title":"Adrenalectomy Lowers Incident Atrial Fibrillation in Primary Aldosteronism Patients at Long Term","volume":"71","author":"Rossi","year":"2018","journal-title":"Hypertension"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2098","DOI":"10.1093\/eurheartj\/ehr266","article-title":"Aldosterone promotes atrial fibrillation","volume":"33","author":"Reil","year":"2012","journal-title":"Eur. Heart J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1159\/000178483","article-title":"Spironolactone prevents aldosterone induced increased duration of atrial fibrillation in rat","volume":"29","author":"Lammers","year":"2012","journal-title":"Cell. Physiol. Biochem."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1016\/j.jacc.2009.09.045","article-title":"Increased Expression of Mineralocorticoid Receptor in Human Atrial Fibrillation and a Cellular Model of Atrial Fibrillation","volume":"55","author":"Tsai","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ijcard.2013.06.046","article-title":"Cross-talk between mineralocorticoid receptor\/angiotensin II type 1 receptor and mitogen-activated protein kinase pathways underlies aldosterone-induced atrial fibrotic responses in HL-1 cardiomyocytes","volume":"169","author":"Tsai","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"6656","DOI":"10.1074\/jbc.M113.519256","article-title":"The mineralocorticoid receptor promotes fibrotic remodeling in atrial fibrillation","volume":"289","author":"Lavall","year":"2014","journal-title":"J. Biol. Chem."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1055\/a-1141-5989","article-title":"Atrial Fibrillation in Primary Aldosteronism","volume":"52","author":"Pan","year":"2020","journal-title":"Horm. Metab. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1055\/s-0035-1565055","article-title":"Aldosterone and Left Ventricular Remodeling","volume":"47","author":"Catena","year":"2015","journal-title":"Horm. Metab. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1038\/s41371-020-00426-y","article-title":"Left ventricular remodeling and dysfunction in primary aldosteronism","volume":"35","author":"Tsai","year":"2021","journal-title":"J. Hum. Hypertens."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e004667","DOI":"10.1161\/CIRCEP.116.004667","article-title":"Electrophysiology of hypokalemia and hyperkalemia","volume":"10","author":"Weiss","year":"2017","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1007\/s11906-013-0354-3","article-title":"Aldosterone mediates cardiac fibrosis in the setting of hypertension","volume":"15","author":"Azibani","year":"2013","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/j.jacc.2007.09.064","article-title":"Atrial Fibrosis: Mechanisms and Clinical Relevance in Atrial Fibrillation","volume":"51","author":"Burstein","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/S0008-6363(97)00097-7","article-title":"Fibrosis of atria and great vessels in response to angiotensin II or aldosterone infusion","volume":"35","author":"Sun","year":"1997","journal-title":"Cardiovasc. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1161\/HYPERTENSIONAHA.114.05001","article-title":"Effect of aldosterone-producing adenoma on endothelial function and Rho-associated kinase activity in patients with primary aldosteronism","volume":"65","author":"Matsumoto","year":"2015","journal-title":"Hypertension"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1038\/40002","article-title":"Signal transduction. Rhomantic interludes raise blood pressure","volume":"389","author":"Somlyo","year":"1997","journal-title":"Nature"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2193","DOI":"10.1093\/eurheartj\/ehi478","article-title":"Spironolactone reduces fibrosis of dilated atria during heart failure in rats with myocardial infarction","volume":"26","author":"Milliez","year":"2005","journal-title":"Eur. Heart J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/00029330-200801010-00008","article-title":"Effects of spironolactone on electrical and structural remodeling of atrium in congestive heart failure dogs","volume":"121","author":"Yang","year":"2008","journal-title":"Chin. Med. J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1584","DOI":"10.1111\/j.1476-5381.2009.00551.x","article-title":"Effects of spironolactone on atrial structural remodelling in a canine model of atrial fibrillation produced by prolonged atrial pacing","volume":"159","author":"Zhao","year":"2010","journal-title":"Br. J. Pharmacol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"5135","DOI":"10.1016\/j.ijcard.2013.08.022","article-title":"Impact of aldosterone antagonists on the substrate for atrial fibrillation: Aldosterone promotes oxidative stress and atrial structural\/electrical remodeling","volume":"168","author":"Mayyas","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.1096\/fj.05-4642fje","article-title":"Aldosterone mediates angiotensin II-induced interstitial cardiac fibrosis via a Nox2-containing NADPH oxidase","volume":"20","author":"Johar","year":"2006","journal-title":"FASEB J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1016\/S0002-9440(10)64454-9","article-title":"Aldosterone-induced inflammation in the rat heart: Role of oxidative stress","volume":"161","author":"Sun","year":"2002","journal-title":"Am. J. Pathol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1161\/01.CIR.0000153800.09920.40","article-title":"Mineralocorticoid receptor inhibition ameliorates the transition to myocardial failure and decreases oxidative stress and inflammation in mice with chronic pressure overload","volume":"111","author":"Kuster","year":"2005","journal-title":"Circulation"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.regpep.2009.12.002","article-title":"Role of Rho kinase and oxidative stress in cardiac fibrosis induced by aldosterone and salt in angiotensin type 1a receptor knockout mice","volume":"160","author":"Kagiyama","year":"2010","journal-title":"Regul. Pept."},{"key":"ref_50","first-page":"414","article-title":"Coupled calcium and zinc dyshomeostasis and oxidative stress in cardiac myocytes and mitochondria of rats with chronic aldosteronism","volume":"53","author":"Kamalov","year":"2009","journal-title":"J. Cardiovasc. Pharmacol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1038\/nm.2506","article-title":"Oxidation of CaMKII determines the cardiotoxic effects of aldosterone","volume":"17","author":"He","year":"2011","journal-title":"Nat. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1161\/CIRCULATIONAHA.113.003313","article-title":"Oxidized Ca2+\/Calmodulin-Dependent Protein Kinase II Triggers Atrial Fibrillation","volume":"128","author":"Purohit","year":"2013","journal-title":"Circulation"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1038\/nrneph.2013.110","article-title":"Contribution of aldosterone to cardiovascular and renal inflammation and fibrosis","volume":"9","author":"Brown","year":"2013","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"4828","DOI":"10.1210\/en.2002-220120","article-title":"Selective aldosterone blockade prevents angiotensin II\/salt-induced vascular inflammation in the rat heart","volume":"143","author":"Rocha","year":"2002","journal-title":"Endocrinology"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1113\/jphysiol.2005.092692","article-title":"A direct relationship between plasma aldosterone and cardiac L-type Ca2+ current in mice","volume":"569","author":"Perrier","year":"2005","journal-title":"J. Physiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1161\/01.RES.85.12.1139","article-title":"Aldosterone upregulates Ca2+ current in adult rat cardiomyocytes","volume":"85","author":"Vassort","year":"1999","journal-title":"Circ. Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.cardiores.2005.05.009","article-title":"Aldosterone increases T-type calcium channel expression and in vitro beating frequency in neonatal rat cardiomyocytes","volume":"67","author":"Rebsamen","year":"2005","journal-title":"Cardiovasc. Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e49","DOI":"10.1161\/CIRCRESAHA.117.312451","article-title":"Specific Activation of the Alternative Cardiac Promoter of Cacna1c by the Mineralocorticoid Receptor","volume":"122","author":"Mesquita","year":"2018","journal-title":"Circ. Res."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1007\/s00210-010-0553-2","article-title":"Effects of selective mineralocorticoid receptor antagonism on atrial ion currents and early ionic tachycardia-induced electrical remodelling in rabbits","volume":"382","author":"Laszlo","year":"2010","journal-title":"Naunyn. Schmiedeberg\u2019s Arch. Pharmacol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"3025","DOI":"10.1161\/CIRCULATIONAHA.104.503706","article-title":"Conditional mineralocorticoid receptor expression in the heart leads to life-threatening arrhythmias","volume":"111","author":"Perrier","year":"2005","journal-title":"Circulation"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1161\/CIRCULATIONAHA.108.805804","article-title":"Mineralocorticoid modulation of cardiac ryanodine receptor activity is associated with downregulation of FK506-binding proteins","volume":"119","author":"Rueda","year":"2009","journal-title":"Circulation"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1161\/CIRCRESAHA.108.184044","article-title":"Gap junction remodeling and spironolactone-dependent reverse remodeling in the hypertrophied heart","volume":"104","author":"Qu","year":"2009","journal-title":"Circ. Res."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1161\/01.RES.71.3.503","article-title":"Immunohistochemical and biochemical evidence for a cardiovascular mineralocorticoid receptor","volume":"71","author":"Oblin","year":"1992","journal-title":"Circ. Res."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1161\/CIR.0b013e3181d47d48","article-title":"2010 ACCF\/AHA\/AATS\/ACR\/ASA\/SCA\/SCAI\/SIR\/STS\/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: Executive summary: A report of the american college of cardiology foundation\/american heart association task force on pra","volume":"121","author":"Hiratzka","year":"2010","journal-title":"Circulation"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.1161\/ATVBAHA.112.300820","article-title":"Mineralocorticoid receptor agonists induce mouse aortic aneurysm formation and rupture in the presence of high salt","volume":"33","author":"Liu","year":"2013","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1007\/s12020-018-1801-3","article-title":"Larger ascending aorta in primary aldosteronism: A 3-year prospective evaluation of adrenalectomy vs. medical treatment","volume":"63","author":"Zavatta","year":"2019","journal-title":"Endocrine"},{"key":"ref_67","first-page":"185","article-title":"Primary aldosteronism. A risk factor for aortic dissection?","volume":"28","author":"Kesri","year":"2003","journal-title":"J. Mal. Vasc."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1536\/ihj.24.995","article-title":"Elevation of plasma renin activity during pregnancy and rupture of a dissecting aortic aneurysm in a patient with primary aldosteronism","volume":"24","author":"Shimizu","year":"1983","journal-title":"Jpn. Heart J."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1177\/000331979905000609","article-title":"Coronary artery aneurysms, aortic dissection, and hypertension secondary to primary aldosteronism: A rare triad\u2014A case report","volume":"50","author":"Safi","year":"1999","journal-title":"Angiology"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/BF02738886","article-title":"The clinicopathologic significance of unilateral adrenal cortical hyperplasia: Report of an unusual case and a review of the literature","volume":"10","author":"Lam","year":"1999","journal-title":"Endocr. Pathol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1159\/000095787","article-title":"Is primary hyperaldosteronism a risk factor for aortic dissection?","volume":"108","author":"Ahmed","year":"2007","journal-title":"Cardiology"},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Luo, F., Fan, P., Meng, X., Yang, K., and Zhou, X. (2020). Is primary aldosteronism a potential risk factor for aortic dissection? A case report and literature review. BMC Endocr. Disord., 20.","DOI":"10.1186\/s12902-020-00601-9"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Boczar, K.E., Boodhwani, M., Beauchesne, L., Dennie, C., Chan, K.L., Wells, G.A., and Coutinho, T. (2020). Aortic Stiffness, Central Blood Pressure, and Pulsatile Arterial Load Predict Future Thoracic Aortic Aneurysm Expansion. Hypertension, 126\u2013134.","DOI":"10.1161\/HYPERTENSIONAHA.120.16249"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/j.amjhyper.2006.02.002","article-title":"Increased Arterial Wall Stiffness in Primary Aldosteronism in Comparison with Essential Hypertension","volume":"19","author":"Wichterle","year":"2006","journal-title":"Am. J. Hypertens."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"2399","DOI":"10.1097\/HJH.0b013e32831286fd","article-title":"Arterial stiffness, intima-media thickness and carotid artery fibrosis in patients with primary aldosteronism","volume":"26","author":"Bernini","year":"2008","journal-title":"J. Hypertens."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"597","DOI":"10.2459\/JCM.0000000000000102","article-title":"The effect of aldosterone-antagonist therapy on aortic elastic properties in patients with nonischemic dilated cardiomyopathy","volume":"16","author":"Vizzardi","year":"2015","journal-title":"J. Cardiovasc. Med."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"2857","DOI":"10.1161\/01.CIR.0000129307.26791.8E","article-title":"Impaired endothelium-dependent flow-mediated vasodilation in hypertensive subjects with hyperaldosteronism","volume":"109","author":"Nishizaka","year":"2004","journal-title":"Circulation"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1111\/jch.13585","article-title":"Hypertension with primary aldosteronism is associated with increased carotid intima-media thickness and endothelial dysfunction","volume":"21","author":"Demirkiran","year":"2019","journal-title":"J. Clin. Hypertens."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1007\/s00380-013-0393-3","article-title":"Impairment of flow-mediated dilation correlates with aortic dilation in patients with Marfan syndrome","volume":"29","author":"Takata","year":"2014","journal-title":"Heart Vessel."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/j.jacc.2009.08.080","article-title":"Endothelial function, carotid-femoral stiffness, and plasma matrix metalloproteinase-2 in men with bicuspid aortic valve and dilated aorta","volume":"55","author":"Tzemos","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/j.ultrasmedbio.2018.01.012","article-title":"Enlarged Size and Impaired Elastic Properties of the Ascending Aorta are Associated with Endothelial Dysfunction and Elevated Plasma Matrix Metalloproteinase-2 Level in Patients with Bicuspid Aortic Valve","volume":"44","author":"Wang","year":"2018","journal-title":"Ultrasound Med. Biol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s11596-010-0362-3","article-title":"Aortic cell apoptosis in rat primary aldosteronism model","volume":"30","author":"Yan","year":"2010","journal-title":"J. Huazhong Univ. Sci. Technol. Med. Sci."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1161\/HYPERTENSIONAHA.108.121954","article-title":"Mineralocorticoid receptor antagonism attenuates vascular apoptosis and injury via rescuing protein kinase B activation","volume":"53","author":"Wei","year":"2009","journal-title":"Hypertension"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1159\/000334091","article-title":"Influence of aldosterone and salt or ouabain in A10 rat aorta smooth muscle cells","volume":"49","author":"Schwerdt","year":"2012","journal-title":"J. Vasc. Res."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s13105-017-0600-2","article-title":"Mineralocorticoid receptor antagonism protects the aorta from vascular smooth muscle cell proliferation and collagen deposition in a rat model of adrenal aldosterone-producing adenoma","volume":"74","author":"Yan","year":"2018","journal-title":"J. Physiol. Biochem."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1186\/s13019-021-01641-5","article-title":"Histological regional analysis of the aortic root and thoracic ascending aorta: A complete analysis of aneurysms from root to arch","volume":"16","author":"Surman","year":"2021","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1161\/01.ATV.17.6.1152","article-title":"Prevention of aortic fibrosis by spironolactone in spontaneously hypertensive rats","volume":"17","author":"Benetos","year":"1997","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/S0735-1097(00)01129-3","article-title":"Prevention of aortic and cardiac fibrosis by spironolactone in old normotensive rats","volume":"37","author":"Lacolley","year":"2001","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"2848","DOI":"10.1161\/01.CIR.0000039328.33137.6C","article-title":"Increased carotid wall elastic modulus and fibronectin in aldosterone-salt-treated rats: Effects of eplerenone","volume":"106","author":"Lacolley","year":"2002","journal-title":"Circulation"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/S0895-7061(04)00811-8","article-title":"Involvement of oxidative stress in the profibrotic action of aldosterone","volume":"17","author":"Iglarz","year":"2004","journal-title":"Am. J. Hypertens."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/S0895-7061(01)02291-9","article-title":"Cardiac and vascular fibrosis and hypertrophy in aldosterone-infused rats: Role of endothelin-1","volume":"15","author":"Park","year":"2002","journal-title":"Am. J. Hypertens."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.lfs.2017.05.002","article-title":"Vascular dysfunction and fibrosis in stroke-prone spontaneously hypertensive rats: The aldosterone-mineralocorticoid receptor-Nox1 axis","volume":"179","author":"Harvey","year":"2017","journal-title":"Life Sci."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1097\/HJH.0b013e3280112ce5","article-title":"Interactions between aldosterone and connective tissue growth factor in vascular and renal damage in spontaneously hypertensive rats","volume":"25","author":"Miana","year":"2007","journal-title":"J. Hypertens."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s00424-007-0211-9","article-title":"Altered collagen homeostasis in human aortic smooth muscle cells (HAoSMCs) induced by aldosterone","volume":"454","author":"Gekle","year":"2007","journal-title":"Pflug. Arch."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/23\/4\/2111\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:19:31Z","timestamp":1760134771000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/23\/4\/2111"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,14]]},"references-count":94,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["ijms23042111"],"URL":"https:\/\/doi.org\/10.3390\/ijms23042111","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,14]]}}}