title: Hypertension caused by primary hyperaldosteronism: increased heart damage and cardiovascular risk.
abstract: OBJECTIVE
  Primary hyperaldosteronism is the most common cause of secondary hypertension. Elevated aldosterone levels cause heart damage and increase cardiovascular morbidity and mortality. Early diagnosis could change the course of this entity. The objective of this report was to study the clinical characteristics, cardiac damage and cardiovascular risk associated with primary hyperaldosteronism.
  
  
  METHODS
  We studied 157 patients with this diagnosis. We analyzed the reason for etiological investigation, and the routinely performed tests, including echocardiography. We used a cohort of 720 essential hypertensive patients followed in our unit for comparison.
  
  
  RESULTS
  Compared with essential hypertensive patients, those with hyperaldosteronism were younger (56.9 [11.7] years vs 60 [14.4] years; P<.001), had higher blood pressure prior to the etiological diagnosis (136 [20.6] mmHg vs 156 [23.2] mmHg), more frequently had a family history of early cardiovascular disease (25.5% vs 2.2%; P<.001), and had a higher prevalence of concentric left ventricular hypertrophy (69% vs 25.7%) and higher cardiovascular risk. Specific treatment resulted in optimal control of systolic and diastolic blood pressures (from 150.7 [23.0] mmHg and 86.15 [14.07] mmHg to 12.69 [15.3] mmHg and 76.34 [9.7] mmHg, respectively). We suspected the presence of hyperaldosteronism because of resistant hypertension (33.1%), hypokalemia (38.2%), and hypertensive crises (12.7%). Only 4.6% of these patients had been referred from primary care with a suspected diagnosis of hyperaldosteronism.
  
  
  CONCLUSIONS
  Hyperaldosteronism should be suspected in cases of resistant hypertension, hypokalemia and hypertensive crises. The diagnosis of hyperaldosteronism allows better blood pressure control. The most prevalent target organ damage is left ventricular hypertrophy.
authors.affiliation: Unidad de Hipertensión, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, España.
authors.forename: María
authors.initials: M
authors.lastname: Abad-Cardiel
authors.forename: Beatriz
authors.initials: B
authors.lastname: Alvarez-Álvarez
authors.forename: Loreto
authors.initials: L
authors.lastname: Luque-Fernandez
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernández
authors.forename: Arturo
authors.initials: A
authors.lastname: Fernández-Cruz
authors.forename: Nieves
authors.initials: N
authors.lastname: Martell-Claros
mesh_terms: D000368:Aged; D000450:Aldosterone / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications* / Q000453:epidemiology; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D000450:Aldosterone; D012083:Renin