Cor Vasa 2002, 43(5):234-242
Cardiac injury in primary hyperaldosteronism and essential hypertension of identical severity
- III. interní klinika, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha, Česká republika
Aim:
To evaluate the clinical relevance of hormonal non-hemodynamic factors for the development of cardiac injury in primary hyperaldosteronism (PHA). To compare the reversibility of cardiac injury after adrenalectomy and spironolactone therapy.
Methods:
Twenty-three patients with aldosterone-producing adenoma (APA), 23 patients with idiopathic hyperaldosteronism (IHA), and 23 patients with essential hypertension (EH) of identical severity were examined by echocardiography. PHA patients were re-examined 2.5 years after adrenalectomy or spironolactone therapy. The subgroups did not differ significantly in terms of age, male/female ratio, and anthropometric markers. Blood pressure (BP) was evaluated by 24-hour monitoring.
Results:
The average values of systolic, diastolic, and mean BP in APA, IHA, and EH were 165/108/127, 166/108/127, and 166/104/125 mm Hg, respectively. Differences among the subgroups in echocardiographic parameters were not significant in a single case. Based on left ventricular mass index (LVMI), relatively mild hypertrophy was present in all subgroups, in less than 50% of all patients. Left ventricular diastolic diameter was not increased. Mean ventricular wall thickness was greater than the upper limit of normal only in IHA patients. Ejection fraction was normal in all patients. An abnormal pattern of left ventricular diastolic filling, as evaluated by Doppler transmitral flow mapping, was most often present in APA patients. In all subgroups, the mean value of peak early and late transmitral diastolic flow rates (E/A) was slightly below the lower limit of normal for the group's mean age. Left ventricular size was close to the upper limit of normal in all subgroups. Left ventricular hypertrophy was mostly concentric. Early left ventricular remodeling was diagnosed in 5 of 15 APA patients without hypertrophy, in 3 of 8 IHA patients, and in 6 of 12 EH patients. A correlation was demonstrated only between diastolic thickness of the interventricular septum and average mean BP (r = 0.426; p = 0.042), and between septal thickness and age (r = 0.428; p = 0.047) in IHA.
Following adrenalectomy, systolic, diastolic and mean BP decreased by 40 ± 12, 28 ± 9, and 30 ± 10 mm Hg on average (p = 0.0002, 0.0003, and 0.0003). in IHA patients, BP values following therapy declined by 23 ± 4, 18 ± 4, and 20 ± 4 mm Hg (p = 0.015, 0.012, and 0.007). The decrease in arterial BP after adrenalectomy was significantly greater than after spironolactone therapy (p = 0.012, 0.036, and 0.009). However, the differences between changes in echocardiographic parameters in APA and IHA were not significant. A correlation was demonstrable between BP decrease and hypertrophy regression in APA.
Conclusions:
The results do not suggest a major clinical effect of the non-hemodynamic mechanisms of hyperaldosteronism in the development of cardiac injury. The reversibility of left ventricular hypertrophy following spironolactone therapy was identical, despite a smaller decrease in pressure, to that seen after adrenalectomy.
Keywords: Primary hyperaldosteronism; Echocardiography; Spironolactone therapy; Adrenalectomy; Cardiac injury reversibility
Published: May 1, 2002 Show citation