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Aldosterone as a key mediator of the cardiometabolic syndrome in primary aldosteronism: an observational study.

Abstract：

OBJECTIVE:Primary aldosteronism (PA) is characterized by the onset of both cardiac and gluco-metabolic alterations. The aim of this study was to evaluate the impact of aldosterone excess on the development of such complications, and the effects of surgical and pharmacological treatment on their long-term outcome. METHODS:We prospectively re-examined 61 patients: 25 with aldosterone-producing adenoma (APA), after surgery, and 36 patients with idiopathic hyperaldosteronism (IHA) on pharmacological treatment. The lipid, fasting and dynamic glucose profiles and the echocardiographic parameters were evaluated at diagnosis and at follow-up. RESULTS:After adrenalectomy all patients had normalization of aldosterone levels and were cured of hypokalaemia, and a resolution of hypertension was achieved in 12 of 25 patients. APA patients showed a significant reduction of both plasma glucose (P=0.017) and insulin levels (P=0.001) after 75 g oral glucose tolerance test. Stabilization of glucose metabolism complications was observed in IHA patients. Multiple regression analysis at diagnosis showed a positive correlation between homeostasis model assessment (HOMA) insulin resistance index and HOMA beta cell and serum aldosterone levels in both APA and IHA. Echocardiographic parameters were improved in both APA and IHA at follow-up and the difference was statistically significant for left ventricular mass index (P=0.017) and interventricular septum thickness (P=0.007) in APA patients. CONCLUSIONS:The removal of aldosterone excess in APA patients induces the regression of both cardiac and gluco-metabolic complications, indicating aldosterone as a main determinant of such alterations. In IHA patients the medical treatment seems to avoid the possible progression of the these alterations that appear to be stable.

journal_name

J Hypertens

journal_title

Journal of hypertension

authors

Giacchetti G,Ronconi V,Turchi F,Agostinelli L,Mantero F,Rilli S,Boscaro M

doi

10.1097/HJH.0b013e3280108e6f

subject

Has Abstract

pub_date

2007-01-01 00:00:00

pages

177-86

issue

eissn

0263-6352

issn

1473-5598

pii

00004872-200701000-00026

journal_volume

pub_type

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Aldosterone as a key mediator of the cardiometabolic syndrome in primary aldosteronism: an observational study.