title: Long-term control of arterial hypertension and regression of left ventricular hypertrophy with treatment of primary aldosteronism.
abstract: Primary aldosteronism (PA), a common cause of high blood pressure (BP), induces left ventricular (LV) hypertrophy and an excess rate of cardiovascular events. Whether its treatment provides long-term cure of hypertension and regression of cardiovascular damage remains uncertain. To the aim of assessing the effect of treatment of PA on BP and LV changes, we prospectively recruited 323 patients in a long-term follow-up study entailing serial echocardiography evaluations. Of them, 180 had PA and were assigned to either adrenalectomy (n=110) or medical therapy (n=70) on the basis of the adrenal vein sampling. The remaining 143 were consecutive optimally treated primary hypertensive patients. At baseline, the PA patients had more inappropriate LV mass than PH patients (27.1% versus 16.2%; P=0.020), despite similar BP values. At a median follow-up of 36 months (range, 6-225), BP was lowered (P<0.0001 versus baseline) to similar values in adrenalectomized (135±15/83±9 mm Hg), medically treated PA (133±11/83±7 mm Hg), and PH (139±15/86±9 mm Hg) patients. To this end, the adrenalectomized patients required significantly less drugs than the other groups. In PA patients, the LV mass index and the rate of LV hypertrophy fell through LV inward remodeling to the level of optimally treated PH patients, indicating that the LV work markedly decreased. Findings were similar when long-term (≥5 and ≥10 years) data were examined. Thus, an early diagnosis and a specific treatment of PA warrant normalization of BP and reversal of detrimental LV changes at long term.
authors: Department of Health Science, University of Milan-Bicocca, Milan, Italy. gianpaolo.rossi@unipd.it
authors: Gian Paolo
authors: GP
authors: Rossi
authors: Maurizio
authors: M
authors: Cesari
authors: Cesare
authors: C
authors: Cuspidi
authors: Giuseppe
authors: G
authors: Maiolino
authors: Maria Verena
authors: MV
authors: Cicala
authors: Valeria
authors: V
authors: Bisogni
authors: Franco
authors: F
authors: Mantero
authors: Achille C
authors: AC
authors: Pessina
mesh_terms: D000315:Adrenalectomy; D001794:Blood Pressure / Q000502:physiology; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D020257:Ventricular Remodeling / Q000502:physiology*
chemical_list: D000451:Mineralocorticoid Receptor Antagonists
keywords: LVH; adrenalectomy; mineralocorticoid receptor antagonists; outcome; primary aldosteronism; remodeling