Long-term cardio- and cerebrovascular events in patients with primary aldosteronism.
BACKGROUND
Aldosterone plays a detrimental role on the cardiovascular system and PA patients display a higher risk of events compared with EH.


OBJECTIVE
The objectives of the study were to compare cardio- and cerebrovascular events in patients with primary aldosteronism (PA) and matched essential hypertension (EH).


METHODS
We retrospectively compared the percentage of patients experiencing events at baseline and during a median follow-up of 12 years in 270 PA patients case-control matched 1:3 with EH patients and in PA subtypes [aldosterone-producing adenoma (n = 57); bilateral adrenal hyperplasia (n = 213)] vs matched EH.


RESULTS
A significantly higher number of PA patients experienced cardiovascular events over the entire period of the study (22.6% vs 12.7%, P < .001). At the diagnosis of PA, a higher number of patients had experienced total events (14.1% vs 8.4% EH, P = .007); furthermore, during the follow-up period, PA patients had a higher rate of events (8.5% vs 4.3% EH, P = .008). In particular, stroke and arrhythmias were more frequent in PA patients. During the follow-up, a higher percentage of PA patients developed type 2 diabetes. Parameters that were independently associated with the occurrence of all events were age, duration of hypertension, systolic blood pressure, presence of diabetes mellitus, and PA diagnosis. After division into PA subtypes, patients with either aldosterone-producing adenoma or bilateral adrenal hyperplasia displayed a higher rate of events compared with the matched EH patients.


CONCLUSIONS
This study demonstrates in a large population of patients the pathogenetic role of aldosterone excess in the cardiovascular system and thus the importance of early diagnosis and targeted PA treatment.
MD, Department of Medical Sciences, Division of Internal Medicine and Hypertension, University of Torino, Via Genova 3, 10126 Torino, Italy. paolo.mulatero@unito.it.
Paolo
P
Mulatero
Silvia
S
Monticone
Chiara
C
Bertello
Andrea
A
Viola
Davide
D
Tizzani
Andrea
A
Iannaccone
Valentina
V
Crudo
Jacopo
J
Burrello
Alberto
A
Milan
Franco
F
Rabbia
Franco
F
Veglio
D000311:Adrenal Glands / Q000473:pathology / Q000503:physiopathology; D018246:Adrenocortical Adenoma / Q000503:physiopathology; D000328:Adult; D000375:Aging; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology; D000075222:Essential Hypertension; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006929:Hyperaldosteronism / Q000209:etiology / Q000503:physiopathology*; D006965:Hyperplasia / Q000473:pathology / Q000503:physiopathology; D006973:Hypertension / Q000503:physiopathology; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology