International Circulation:  Regarding aldosterone， we know it is also involved in the renin-angiotensin system.  Is there presently a therapeutic strategy that specifically targets aldosterone for the treatment of cardiovascular diseases?

Ernesto Schiffrin:  There is no doubt that aldosterone plays an important pathophysiological role， both in hypertension and in heart failure， as well as chronic kidney disease.  The use of mineral corticosteroid receptor blockers added to other agents may contribute significantly to protect patients who have heart failure， hypertension， or chronic kidney disease， in the later because of the problem in controlling potassium there are some caution that has to be exercised.  Going back to hypertension it is my experience that patients with resistant hypertension very often rapidly respond to the use of or addition of mineral corticosteroid receptor blocker with very significant reduction in blood pressure.  In those conditions mineral corticosteroid receptor blockade， blocking the action of aldosterone is extremely effective in heart failure.  There is no doubt that the use of mineral corticosteroid receptor blockers， as demonstrated in the Brose Trial， and post myocardial infarction as demonstrated in the Effisus Trial， is an extremely effective therapeutic approach.  Many years ago my mentor published a paper in Science in 1956 where he called hypertension a form of mild hyperaldosteronism.  We now know 50 years later that aldosterone has an important pathophysiological role to play in hypertension， heart failure， and cardiovascular disease in general.