Endocrine Abstracts

Introduction

Primary aldosteronism (PA) is associated with cardiovascular events and target organ damage, such as left ventricular (LV) hypertrophy and cardiac dysfunction. However the impact of subtle aldosterone secretion on cardiac function has not yet been evaluated.

Aim

To prospectively evaluate the cardiac function using echocardiographic indices in patients with biochemical overt, mild PA and essential hypertension (EH) and investigate the impact of targeted therapy.

Patients and methods

We included 72 (44 men) patients (mean age 55 ± 11 years) with hypertension. The diagnosis of PA was based on the combination of valsartan, captopril and dexamethasone suppression test (DCVT)¹. The patients were divided in three groups: those with EH (n = 30) (negative DCVT), with biochemical overt (n = 21)(basal aldosterone/renin ratio (ARR) > 67 pmol/mU² and positive DCVT) and with mild PA (n = 19)(ARR < 67pmol/ mU and positive DCVT). Mean blood pressure, LV diastolic and systolic dimensions (LVEDD, LVEDDi, LVESD, LVESDi), left ventricular and atrial mass index (LVMI, LAVI), and total diastolic function were evaluated with cardiac ultrasound at presentation and after targeted treatment. The delta values of the abovementioned parameters were calculated to evaluate the magnitude of therapeutic impact among the three groups.

Results

At presentation, LVMI (88.19 17.44 vs 73.34 ± 11.85) (P = 0.001), LAVI (38.01 ± 14.5 vs 27.74 ± 5.12) (P = 0.001) and LVESDi (15.65 ± 2.36 vs 14.39 ± 2.01) (P = 0.041) were significant higher in overt PA vs EH patients. Mild PA have also higher LVMI(80.26 ± 19.99 vs 73.34 ± 11.85) (P = 0.052), LAVI(31.05 ± 5.6 vs 27.74 ± 5.12) (P = 0.058), and LVEDDi (22.82 ± 2.9 vs 22.41 ± 2.11) (P = 0.015) vs EH patients. When biochemical overt and mild PA patients were compared, ejection fraction (63.66 ± 6.25 vs 64.34 ± 11.83) was lower and LVMI (88.19 ± 17.44 vs 80.26 ± 19.99) was higher in biochemical overt PA patients, compared to mild PA.The mean follow up, during treatment (MRAs for PA and conventional therapy for EH) was 14 ± 2months. Delta values of LVEDD (P < 0.001) and LVEDDi (P = 0.002) were significant higher in overt and mild PA patients, showing a significant improvement of cardiac function from baseline in comparison with EH patients. Furthermore, biochemical overt PA patients exhibited a significant improvement of LVESD (-2.31 ± 3.5 vs -0.6 ± 2.32, P = 0.015), LVEDDi (-1.77 ± 1.8 vs -0.57 ± 1.15, P = 0.013) and LVESVi (-5.44 ± 3.93 vs 0.9 ± 7.76, P = 0.002) compared to mild PA patients.

Conclusion

The present study shows that milder forms of PA have a similar though more subtle effect on cardiac function, compared to biochemical overt forms. Furthermore, targeted treatment resulted in a significant greater improvement in patients with overt forms of PA.

References

1. Eur J Endocrinol. 2016; 175(1):21 –28.

2. Eur J Clin Invest. 2014; 44(8):697 –706.