Reversible sympathetic overactivity in hypertensive patients with primary aldosteronism.
BACKGROUND
Aldosterone has been shown to exert a central sympathoexcitatory action in multiple animal models, but evidence in humans is still lacking.


OBJECTIVE
Our objective was to determine whether hyperaldosteronism causes reversible sympathetic activation in humans.


METHODS
We performed a cross-sectional comparison of muscle sympathetic nerve activity (SNA, intraneural microelectrodes) in 14 hypertensive patients with biochemically proven primary aldosteronism (PA) with 20 patients with essential hypertension (EH) and 18 age-matched normotensive (NT) controls. Seven patients with aldosterone-producing adenoma (APA) were restudied 1 month after unilateral adrenalectomy.


RESULTS
Mean blood pressure values in patients with PA and EH and NT controls was 145 ± 4/88 ± 2, 150 ± 4/90 ± 2, and 119 ± 2/76 ± 2 mm Hg, respectively. The major new findings are 2-fold: 1) baseline SNA was significantly higher in the PA than the NT group (40 ± 3 vs. 30 ± 2 bursts/min, P = 0.014) but similar to the EH group (41 ± 3 bursts/min) and 2) after unilateral adrenalectomy for APA, SNA decreased significantly from 38 ± 5 to 27 ± 4 bursts/min (P = 0.01), plasma aldosterone levels fell from 72.4 ± 20.3 to 11.4 ± 2.3 ng/dl (P < 0.01), and blood pressure decreased from 155 ± 8/94 ± 3 to 117 ± 4/77 ± 2 mm Hg (P < 0.01).


CONCLUSIONS
These data provide the first evidence in humans that APA is accompanied by reversible sympathetic overactivity, which may contribute to the accelerated hypertensive target organ disease in this condition.
Kontak
Andrew C
AC
Cardiology Division, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8586, USA.
Wang
Zhongyun
Z
Arbique
Debbie
D
Adams-Huet
Beverley
B
Auchus
Richard J
RJ
Nesbitt
Shawna D
SD
Victor
Ronald G
RG
Vongpatanasin
Wanpen
W
D000315:Adrenalectomy; D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000503:physiopathology*; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D013564:Sympathetic Nervous System / Q000502:physiology / Q000503:physiopathology*