2) This program is intended for #HCPs & is supported by an unrestricted educational grant from AstraZeneca. Statement of accreditation & faculty disclosures at https://t.co/gvXca4G9Xm. Follow this 🧵for 0.75 hr 🆓CE/#CME credit–all delivered right here on X!
— cardio-met (@cardiomet_CE) May 28, 2025
4)⚠️ ⬇️eGFR & ⬆️albuminuria independently worsen outcomes:
— cardio-met (@cardiomet_CE) May 28, 2025
→ #CKD progression
→ #CV death, #MI, #stroke
→ #HF, #AFib, #PAD, hospitalization
🔗 🔓 https://t.co/OrpstC1PIN pic.twitter.com/jY7UAX9mxW
6) 🩺 We know #BP reduction improves #CV outcomes… pic.twitter.com/8LtCxwe4ly
— cardio-met (@cardiomet_CE) May 28, 2025
8) #RAASi changed the game in diabetic #nephropathy:
— cardio-met (@cardiomet_CE) May 28, 2025
→ ↓ risk #Albuminuria
→ ↓ risk of CV & renal outcomes
Now standard #GDMT in #cardiorenal disease.
– IDNT: #Irbesartan → 🔓https://t.co/pB0zze8kuD
– RENAAL: #Losartan → 🔓https://t.co/t18s83E0vU pic.twitter.com/4FCg6A7Dow
10) We’ve since entered a renaissance of #BP 🎯 trials:
— cardio-met (@cardiomet_CE) May 28, 2025
🩺 #SPRINT
🩺 #STEP
🩺 #ESPRIT
🩺 #BPROAD
All show benefits for intensive BP (<120/80) in diverse populations.
12) Risk of reduced #eGFR in intensive BP control group was later determined to be related to hemodynamic shifts without increase of #kidney injury biomarkers.https://t.co/sHqdav3w78 pic.twitter.com/IqvXLUgoP0
— cardio-met (@cardiomet_CE) May 28, 2025
14) #STEP: In elderly (110–130 vs. 130–<150 mmHg)
— cardio-met (@cardiomet_CE) May 28, 2025
✔️ CV benefit
⚠️ Slight ↑ in hypotension risk
🔓 https://t.co/UNptKKvVEL pic.twitter.com/LrTRbuUmgn
16) BPROAD: Strong #CV benefit, no renal harm
— cardio-met (@cardiomet_CE) May 28, 2025
🔓 https://t.co/D0EeFPKZth
🔓 https://t.co/NkXvtwHTNN pic.twitter.com/kVUDcIl26N
18) New evidence demonstrates the importance of individualizing care, considering strict targets for our higher-risk patients.
— cardio-met (@cardiomet_CE) May 28, 2025
📉 High-risk = High priority.
Individualized care is 🔑.
Higher #BP & more risk factors = more #cardiorenal events.
🔓 https://t.co/5DKeoBS0UK pic.twitter.com/rP5JOo0SeN
20) 🫀🧠Enter: Cardiac Kidney Metabolic (CKM) Syndrome
— cardio-met (@cardiomet_CE) May 28, 2025
Cardiac + Renal + Metabolic dysfunction = 🔁 interconnected
🔓 https://t.co/xbvC6rpBKU
🔓 https://t.co/su3vEzzT6i pic.twitter.com/vc20rKV3Bq
22) First isolated in 1953 by Simpson & Tait, #aldosterone is a powerful #mineralocorticoid secreted by the adrenal cortex.
— cardio-met (@cardiomet_CE) May 28, 2025
Its main role (at least, in the setting of #hypovolemia)?
24) How does #aldosterone regulate #BP?
— cardio-met (@cardiomet_CE) May 28, 2025
✔️ Promotes Na⁺ reabsorption
✔️ Drives K⁺ excretion
✔️ Retains volume
✔️ Alters vascular tone
✔️ Activates central sympathetic pathways
🔓 https://t.co/CvInpmfzW6 pic.twitter.com/uAvn1BNse2
26) But first, a question
— cardio-met (@cardiomet_CE) May 28, 2025
Which factor stimulates aldosterone production outside of the #RAAS?
A. Hypernatremia
B. Cortisol
C. Leptin (via adipose tissue)
D. ↑ Parasympathetic tone
28) #Leptin directly stimulates #aldosterone production in adrenal #glomerulosa cells—linking #obesity, #metabolic_syndrome & aldosterone dysregulation
— cardio-met (@cardiomet_CE) May 28, 2025
🔓 https://t.co/jpFJqou0jQ pic.twitter.com/lNWr4FJ6Ot
30) Primary Aldosteronism #PA isn’t rare!
— cardio-met (@cardiomet_CE) May 28, 2025
Also seen in normotensive & stage 1–2 HTN, #redefining our understanding of the disease. Dysregulated #aldosterone is implicated in diseases like essential #hypertension.
🔓 https://t.co/RL5pqo1WPb pic.twitter.com/HXF3DYHBxl
32) #CKD & #T2D = also suffer from #aldosterone-mediated injury, amongst other mediators, including
— cardio-met (@cardiomet_CE) May 28, 2025
→ #Albuminuria
→ #Fibrosis
→ #Glomerulosclerosis
🔓 https://t.co/su3vEzzT6i pic.twitter.com/NkPYJecIrm
33b)⚠️ MR activation outside hypotension is mediated via aldosterone (ligand) & non-ligand stimulation, driving
— cardio-met (@cardiomet_CE) May 28, 2025
🚨 Inflammation
🚨 Fibrosis
🚨 Vascular dysfunction
34) In #heartfailure, #aldosterone and non-ligand MR activation worsens:
— cardio-met (@cardiomet_CE) May 28, 2025
🫀 Cardiac remodeling
💦 Volume overload
🧠 #Neurohormonal activation
🔓 https://t.co/HejFwYYYPA pic.twitter.com/d0pk8NXY6z
36) #RAASi is insufficient in primary aldosteronism#Aldosterone breakthrough occurs in patients with #heartfailure & #CKD due to complex mechanisms theorized to be due to
— cardio-met (@cardiomet_CE) May 28, 2025
– Non-ligand MR activity (see above)
– Non-genomic activity
– #AT2 dependent activity
38) There is debate that what was previously thought to be rapid, non-genomic #aldosterone activity may actually reflect non-ligand MR activation. However, data remain in support of the less understood non-genomic activity 👇
— cardio-met (@cardiomet_CE) May 28, 2025
40) More recent studies have shown that the #GPER-1 mediates some of the rapid effects of #aldosterone in vascular endothelial cells and in the heart
— cardio-met (@cardiomet_CE) May 28, 2025
See https://t.co/Pm3qHCPpFj pic.twitter.com/wbU1IkL7rK
42) Why might aldosterone synthase inhibitors #ASIs offer an advantage over #MRAs?
— cardio-met (@cardiomet_CE) May 28, 2025
A. They ↑ #aldosterone
B. Block it at the renal tubule
C. Inhibit aldosterone synthesis upstream of MR activation
D. Only reduce BP, not proteinuria
44) #MRAs have significant cardiorenal data supporting their efficacy pic.twitter.com/VSih1Q0X4U
— cardio-met (@cardiomet_CE) May 28, 2025
46) 🔁 Recap:
— cardio-met (@cardiomet_CE) May 28, 2025
✔️ Aldosterone = key in BP & fluid balance
✔️ MR activation can occur even w/ normal aldosterone
✔️ Dysregulation worsens HF, CKD, T2D
✔️ MRAs & new inhibitors = essential tools
48) If u want to learn more & see @sophia_kidney in person, you are in luck 🍀if you're attending #ERA25 in Vienna 🇦🇹! See https://t.co/TlZBIaK1Gc & plan to attend on June 5! pic.twitter.com/9EgRI1K5SN
— cardio-met (@cardiomet_CE) May 28, 2025
49) Meanwhile, you just earned 0.75 hr 🆓 CE/#CME credit! Point your 🖱️ to https://t.co/MTWndPscBM to claim your certificate! Thanks to @sophia_kidney for leading this program! Follow us here @cardiomet_ce for more expert-led #MedEd, always 🆓!
— cardio-met (@cardiomet_CE) May 28, 2025