FIGURE 1.

Opportunities to mitigate the effect of aldosterone. Aldosterone drives fibrosis and inflammation, and reducing angiotensin II is made from angiotensin I from angiotensin converting enzyme or chymase activity, and can be reduced with angiotensin converting enzyme inhibitors or chymase inhibitors. Angiotensin II and potassium stimulates production of aldosterone and angiotensin II receptor blockers blocks the angiotensin II receptor type 1. Aldosterone formation can also be mitigated by inhibition of aldosterone synthesis, and the mineralocorticoid receptor mediated effects blocked with steroidal or nonsteroidal mineralocorticoid receptor antagonists. Hyperkalemia is a limiting side effect with several options but may be treated potassium binders.