Abstract
Primary aldosteronism is the most frequent cause of secondary hypertension. Here we present the hypothesis that the increasing incidence of primary aldosteronism is a consequence of chronic aldosterone stimulation from present day lifestyle and dietary conditions. We review epidemiological and pathophysiological evidence supporting the role of obesity, insulin resistance, hyperlipidemia, obstructive sleep apnea, and western style diet in the chronic stimulation of aldosterone secretion, with a special focus on the role of fructose in stimulating adrenocorticotropic hormone and angiotensin II expression. Sustained stimulation of clusters of aldosterone secreting cells in normal adrenal glands harboring gene mutations of aldosterone synthase and adrenocorticotropic hormone receptor would represent second-hits that eventually result in autonomous aldosterone secretion and primary aldosteronism.
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