Cardiovascular changes in patients with primary aldosteronism after surgical ormedical treatment

摘要

Background: Data on the cardiovascular middle-term follow-up of patients with primary aldosteronism (PA) are scanty. Aim: To detect the cardiovascular effects of surgery in patients with aldosterone (ALD)-producing adenoma (APA) and of pharmacotherapy in those with bilateral adrenal hyperplasia (BAH), a prospective study involving 60 consecutive patients with PA was performed. Material/methods: Clinical, biochemical, and cardiovascular assessment was obtained before and after (31.5±4.4 months) surgery or proper medical treatment (32.1±5.0 months) in 19 and 41 patients, respectively. Results: As expected, plasma ALD normalized in all operated patients, while in the other group it did not change. Systolic and diastolic blood pressure decreased (p0.001) after both treatments. However, absolute and percentage reduction was significantly more pronounced (p0.01) in operated than in non-operated patients. Left ventricular (LV) mass showed significant reduction after surgery (LV mass g/m 2, p0.0007; LV mass g/m 2.7, p0.01), but no change after medical treatment, so that the differences between absolute and percentage values at follow-up were statistically significant (p0.01) between groups. Basal LV mass/m 2.7 was positively associated with age (p0.009), body mass index (p0.0008), drug number (p0.03), and ALD/plasma renin activity ratio (p0.01). Allocating the patients according to plasma ALD and cardiac parameters, patients who presented ALD reduction during the study also had a decrement in cardiac mass (p0.04). Conclusions: Our data indicate that in patients with PA the removal of ALD excess by surgery in APA is effective in reducing blood pressure and in improving cardiac parameters, while anti-hypertensive therapy in BAH shows less positive impact on cardiovascular system.