title: Arterial stiffness, intima-media thickness and carotid artery fibrosis in patients with primary aldosteronism.
abstract: OBJECTIVE
  To evaluate vascular wall structure and conduit artery stiffness in patients with primary aldosteronism.
  
  
  METHODS
  This observational study, conducted in a University Hypertension Center, evaluated the carotid wall by 2-D ultrasonography and ultrasonic tissue characterization, and analyzed arterial stiffness by applanation tonometer. Twenty-three consecutive patients with primary aldosteronism, 24 matched patients with essential hypertension and 15 controls were studied. Intima-media thickness and corrected integrated backscatter signal of the carotid arteries were evaluated. Radial and femoral pulse wave velocity and aortic augmentation index were also investigated.
  
  
  RESULTS
  Intima-media thickness in patients with essential hypertension (0.69 +/- 0.03 mm) was higher (P < 0.04) than that in controls (0.59 +/- 0.02 mm). This finding was more evident in primary aldosteronism patients (0.84 +/- 0.03 mm), in whom intima-media thickness was greater than that in controls (P < 0.0001) or in patients with essential hypertension (P < 0.01). Similarly, corrected integrated backscatter signal in patients with essential hypertension (-23.6 +/- 0.35 dB) was higher (P < 0.0001) than that in controls (-26.2 +/- 0.44 dB), but it was even more elevated in patients with primary aldosteronism (-22.1 +/- 0.46 dB), who showed greater corrected integrated backscatter signal than was the case in patients with essential hypertension (P < 0.009) or in controls (P < 0.0001). Femoral pulse wave velocity was higher in primary aldosteronism patients (10.8 +/- 0.57 m/s) than in patients with essential hypertension (9.1 +/- 0.34 m/s, P < 0.03) or in controls (7.1 +/- 0.51 m/s, P < 0.0001). Femoral pulse wave velocity was lower in controls than in patients with essential hypertension (P < 0.0001). The same pattern was observed for radial pulse wave velocity. Aortic augmentation index was higher in primary aldosteronism patients (28.2 +/- 2.1%) than in patients with essential hypertension (26.0 +/- 1.8%) or in controls (16.8 +/- 2.0%, P < 0.001). Patients with essential hypertension likewise exhibited higher aortic augmentation index than controls (P < 0.001).
  
  
  CONCLUSIONS
  Aldosterone excess is responsible per se for vascular morphological (wall thickening and carotid artery fibrosis) and functional (central stiffness) damage.
authors.affiliation: Department of Internal Medicine, University of Pisa, Pisa, Italy. g.bernini@med.unipi.it
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bernini
authors.forename: Fabio
authors.initials: F
authors.lastname: Galetta
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Franzoni
authors.forename: Michele
authors.initials: M
authors.lastname: Bardini
authors.forename: Chiara
authors.initials: C
authors.lastname: Taurino
authors.forename: Melania
authors.initials: M
authors.lastname: Bernardini
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ghiadoni
authors.forename: Matteo
authors.initials: M
authors.lastname: Bernini
authors.forename: Gino
authors.initials: G
authors.lastname: Santoro
authors.forename: Antonio
authors.initials: A
authors.lastname: Salvetti
mesh_terms: D001011:Aorta / Q000503:physiopathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D016022:Case-Control Studies; D004548:Elasticity / Q000502:physiology*; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology; D005355:Fibrosis; D006801:Humans; D006929:Hyperaldosteronism / Q000473:pathology* / Q000503:physiopathology*; D006973:Hypertension / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow / Q000502:physiology; D017534:Radial Artery / Q000503:physiopathology; D012039:Regional Blood Flow / Q000502:physiology; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology*; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography