title: Long-term effects of adrenalectomy or spironolactone on blood pressure control and regression of left ventricle hypertrophy in patients with primary aldosteronism.
abstract: BACKGROUND
  Primary aldosteronism (PA) represents the most common cause of secondary hypertension. Beyond increased blood pressure, additional harmful effects of aldosterone excess including inappropriate left ventricle (LV) hypertrophy were found. We evaluated the effect of adrenalectomy and spironolactone on blood pressure and myocardial remodelling in a long-term follow-up study.
  
  
  METHODS
  Thirty-one patients with PA were recruited. Fifteen patients with confirmed aldosterone-producing adenoma underwent adrenalectomy; in the remaining 16 patients, treatment with spironolactone was initiated. Laboratory data, 24-hour ambulatory blood pressure monitoring (ABPM) and echocardiography parameters were evaluated at baseline and at a median follow-up of 64 months.
  
  
  RESULTS
  Both approaches reduced blood pressure (p = 0.001 vs. baseline). In both groups we observed a decrease in end-diastolic (p = 0.04, p = 0.01) and end-systolic LV cavity diameters (p = 0.03, p = 0.01). Interventricular septum and posterior wall thickness reduction was significant only after adrenalectomy (p = 0.01, p = 0.03) as was reduction of LV mass index (p = 0.004). A trend to lower LV mass on spironolactone was caused predominantly by diminution of the LV cavity, which was reflected in increased relative wall thickness (p = 0.05).
  
  
  CONCLUSIONS
  Although both surgical and conservative treatment can induce a long-term decrease of blood pressure, adrenalectomy seems to be more effective in reduction of LV mass, as it reverses both wall thickening and enlargement of the LV cavity.
authors.affiliation: Third Department of Internal Medicine, General University Hospital, Prague, Czech Republic; and First Faculty of Medicine, Charles University, Prague, Czech Republic tomas.indra@vfn.cz.
authors.forename: Tomáš
authors.initials: T
authors.lastname: Indra
authors.affiliation: Third Department of Internal Medicine, General University Hospital, Prague, Czech Republic; and First Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Robert
authors.initials: R
authors.lastname: Holaj
authors.affiliation: Third Department of Internal Medicine, General University Hospital, Prague, Czech Republic; and First Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Branislav
authors.initials: B
authors.lastname: Štrauch
authors.affiliation: Third Department of Internal Medicine, General University Hospital, Prague, Czech Republic; and First Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Ján
authors.initials: J
authors.lastname: Rosa
authors.affiliation: Third Department of Internal Medicine, General University Hospital, Prague, Czech Republic; and First Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Ondřej
authors.initials: O
authors.lastname: Petrák
authors.affiliation: Third Department of Internal Medicine, General University Hospital, Prague, Czech Republic; and First Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Šomlóová
authors.affiliation: Third Department of Internal Medicine, General University Hospital, Prague, Czech Republic; and First Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Jiří
authors.initials: J
authors.lastname: Widimský
mesh_terms: D000315:Adrenalectomy; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013148:Spironolactone / Q000494:pharmacology / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents; D013148:Spironolactone
keywords: Primary aldosteronism; adrenalectomy; echocardiography; hypertension; left ventricle hypertrophy