RALES, EPHESUS and redox

MR in VSMC and cardiomyocytes are normally predominantly occupied by cortisol in tonic inhibitory mode. Blockade of 11β hydroxysteroid dehydrogenase type II (11βHSD2) or ROS generation both serve to activate cortisol-MR complexes, thus mimicking the effects of mineralocorticoid/salt imbalance on blood vessels and the heart. In RALES and EPHESUS, it is likely that the antagonists are blocking normal levels of cortisol, not aldosterone, from activating MR in the context of tissue damage and ROS generation. If this is the case, MR antagonists may be of wide therapeutic potential in cardiovascular disease and not confined to those characterized by aldosterone/salt excess. Finally, the pathophysiologic roles of always-occupied MR in 'unprotected' tissues such as cardiomyocytes or neurons in response to altered intracellular redox status remain to be explored.