Unravelling drug-induced hypertension: molecular mechanisms of aldosterone-independent mineralocorticoid receptor activation by posaconazole.

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Unravelling drug-induced hypertension: molecular mechanisms of aldosterone-independent mineralocorticoid receptor activation by posaconazole.

Clin Kidney J. 2018 Oct;11(5):688-690

Authors: Sanchez-Niño MD, Ortiz A

Abstract
Drug-induced hypertension offers the opportunity to further understand pathways involved in the regulation of blood pressure. Posaconazole is an antifungal agent known to induce hypertension and hypokalaemia. In recent months, a flurry of reports has unravelled the metabolic processes involved. In this issue of CKJ, Barton K, Davis TK, Marshall B et al. Posaconazole-induced hypertension and hypokalemia due to inhibition of the 11β-hydroxylase enzyme. Clin Kidney J 2018; 11: 691-693 present convincing evidence of 11β-hydroxylase inhibition resulting in a biochemical syndrome resembling genetic congenital adrenal hyperplasia and characterized by high 11-deoxycorticosterone and 11-deoxycortisol levels as well as androgen levels. This adds to prior evidence supporting inhibition of 11β-hydroxysteroid dehydrogenase 2, the enzyme that inactivates cortisol in aldosterone-sensitive tissues such as the kidneys, yielding a syndrome resembling genetic apparent mineralocorticoid excess or licorice toxicity, characterized by a high cortisol/cortisone ratio.

PMID: 30289131 [PubMed]