Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism.
OBJECTIVE
The aim of this report was to show that the rate of cardiovascular events is increased in patients with either subtype of primary aldosteronism (PA).


BACKGROUND
Primary aldosteronism involves hypertension (HTN), hypokalemia, and low plasma renin. The two major PA subtypes are unilateral aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia.


METHODS
During a three-year period, the diagnosis of PA was made in 124 of 5,500 patients referred for comprehensive evaluation and management. Adenomas were diagnosed in 65 patients and idiopathic hyperaldosteronism in 59 patients. During the same period, clinical characteristics and cardiovascular events of this group were compared with those of 465 patients with essential hypertension (EHT) randomly matched for age, gender, and systolic and diastolic blood pressure.


RESULTS
A history of stroke was found in 12.9% of patients with PA and 3.4% of patients with EHT (odds ratio [OR] = 4.2; 95% confidence interval [CI] 2.0 to 8.6]). Non-fatal myocardial infarction was diagnosed in 4.0% of patients with PA and in 0.6% of patients with EHT (OR = 6.5; 95% CI 1.5 to 27.4). A history of atrial fibrillation was diagnosed in 7.3% of patients with PA and 0.6% of patients with EHT (OR = 12.1; 95% CI 3.2 to 45.2). The occurrence of cardiovascular complications was comparable in both subtypes of PA.


CONCLUSIONS
Patients presenting with PA experienced more cardiovascular events than did EHT patients independent of blood pressure. The presence of PA should be detected, not only to determine the cause of HTN, but also to prevent such complications.
Milliez
Paul
P
Department of Cardiology, Lariboisière Hospital, Paris, France.
Girerd
Xavier
X
Plouin
Pierre-François
PF
Blacher
Jacques
J
Safar
Michel E
ME
Mourad
Jean-Jacques
JJ
D000236:Adenoma / Q000150:complications; D000310:Adrenal Gland Neoplasms / Q000150:complications; D000312:Adrenal Hyperplasia, Congenital / Q000150:complications; D001281:Atrial Fibrillation / Q000209:etiology; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications* / Q000209:etiology; D006973:Hypertension / Q000150:complications; D007008:Hypokalemia / Q000150:complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D012083:Renin / Q000097:blood; D020521:Stroke / Q000209:etiology
D012083:Renin