Neurohormonal Activation in Populations Susceptible to Heart Failure

During the course of evolution, life forms moved from an aquatic to a terrestrial environment and a need for salt conservation arose. The neurohormonal defense systems that evolved to ensure salt and circulatory homeostasis have been essential for survival. For instance, the renin–angiotensin–aldosterone system (RAAS) played a fundamental role in promoting water and sodium retention, and in facilitating potassium excretion in prehistoric humans, hunter-gatherers who consumed a diet high in potassium and who were prone to death from hemorrhage or diarrhea [1]. As our living conditions have changed over millions of years, however, the need for salt conservation has diminished and the neurohormonal systems essential to survival in prehistoric times may become maladaptive under select circumstances. Consequently, the term neurohormonal activation often has a negative connotation, despite it being a mechanism essential for species preservation under some conditions. This article focuses on the adverse effects of neurohormonal activation, acknowledging that it is