STRUCTURAL AND FUNCTIONAL CHANGES IN THE HEART AND LARGE ARTERIES IN PATIENTS WITH PRIMARY ALDOSTERONISM OR ESSENTIAL HYPERTENSION

Background: Previous studies have suggested that patients with primary aldosteronism(PA) may have a greater prevalence of left ventricular (LV) hypertrophy. Only few studies, in small groups of patients, have evaluated large arteries alterations. In addition, the assessment of cardiac and vascular involvement has not been simultaneously performed. Aim of the study was to evaluate cardiac, vascular and renal complications in patients with PA. Patients and Methods: 70 patients with PA (n = 56 with adrenal hyperplasia and n = 14 with adenoma; age 49 ± 6 years, 27 F) and 70 essential hypertensives (EH) matched for age, sex, BMI and clinic BP, underwent laboratory examinations, cardiac and carotid ultrasound, pulse wave velocity (PWV) and pulse wave analysis assessment. Results: By definition no differences in age, sex, BMI, BP and heart rate were observed. Total cholesterol was slightly lower in PA (195 ± 37 mg/dl vs. 215 ± 33 mg/dl, p < 0.05); no difference in triglycerides, glucose and uric acid was observed. In PA eGFR(MDRD) was greater in comparison to EH(96 ± 22 ml/min/1.73 m2 vs. 89 ± 17 ml/min/1.73 m2, p = 0.05). LV mass index (LVMI) and relative wall thickness (RWT) were significantly greater in PA vs. EH (LVMI 42 ± 13g/m2.7 vs. 34 ± 7 g/m2.7, p < 0.001 and RWT 0.34 ± 0.08 vs. 0.31 ± 0.04, p < 0.001). At tissue Doppler analysis Em vel was significantly lower, and Evel/Emvel was significantly higher in PA (9.5 ± 2.9 vs. 10.5 ± 2.7, p < 0.05 and 9.2 ± 4.4 vs. 7.6 ± 2.7, p < 0.05, respectively). No difference was observed in carotid prevalence of thickening or plaques and in IMT (Meanmax 1.02 ± 0.25 vs. 0.98 ± 0.18, p ns, CBMMax 1.05 ± 0.26 vs. 1.01 ± 0.16, p ns), as well as in PWV (10.8 ± 2.1 m/s vs. 10.8 ± 1.6 m/s, p ns). In patients with PA plasma aldosterone was significantly related to LVMI (r = 0.47, p < 0.001), RWT (r = 0.33, p < 0.01) but not to carotid IMT and PWV. Conclusion: In this large group of patients with PA a significant increase in LVMI and concentric geometry, associated with a worse diastolic function was observed. In patients with PA a trend toward greater eGFR was also shown, possibly indicating, as previously reported, hyperfiltration. Opposite to previous findings, no difference in aortic stiffness and carotid structure was observed.