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Nadir Aldosterone Levels After Confirmatory Tests Are Correlated With Left Ventricular Hypertrophy in Primary Aldosteronism.

From the Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.O., M.S., N.I., A.K.). Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan (M.S.). Department of Internal Medicine (Y.T.), Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. Department of Health Promotion and Medicine of the Future (T. Yoneda), Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan (I.K., H.I.). Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (M.T.). Department of Diabetes and Endocrinology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan (T.I.). Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan (T.K.). Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan (N.W.). Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (R.S., Y.O.). Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Tokyo, Japan (T. Yoshimoto, T. Yamada). Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan (J.K.). Department of Cardiology, Sanda City Hospital, Sanda, Japan (Y.M.). Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo, Japan (H.K.). Division of Cardiovascular Medicine, Department of Internal Medicine, Shinko Hospital, Kobe, Japan (K.K.). Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan (K.Y.). Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan (M.O.). Departoment of Endocrinology, Tenri Hospital, Tenri, Japan (S.O.). Department of Endocrinology and Metabolism, Tottori University Hospital, Yonago, Japan (S.I.). Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan (R.O.). Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Japan (K.T.). Division of Endocrinology, National Center for Global Health and Medicine, Tokyo, Japan (A.T.). Clinical Researh Institute of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center and Endocrine Center, Ijinkai Takeda General Hospital, Kyoto, Japan (M.N.).

Hypertension (Dallas, Tex. : 1979). 2020;(6):1475-1482
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Abstract

Left ventricular hypertrophy (LVH) is often seen in patients with primary aldosteronism (PA), and the prevalence of LVH is reportedly higher among patients with PA than patients with essential hypertension. However, the correlation between aldosterone levels and LVH is undefined, and how aldosterone affects LVH in patients with PA remains unclear. We, therefore, retrospectively assessed a large PA database established by the multicenter JPAS (Japan Primary Aldosteronism Study) to reveal the factors associated with LVH in patients with PA without suspected autonomous cortisol secretion. In the 1186 patients with PA studied, the basal plasma aldosterone concentration, plasma renin activity, and the aldosterone-to-renin ratio did not significantly correlate with left ventricular LV mass index (LVMI) in single or multiple regression analyses. However, the plasma aldosterone concentration after the captopril challenge test or saline-infusion test, which are associated with autonomous aldosterone secretion, correlated significantly with LVMI, even after adjusting for patients' backgrounds, including age and blood pressure. In addition, hypokalemia and the unilateral subtype also correlated with LVMI. Longitudinal subanalysis of medically or surgically treated patients with PA showed significant reductions in LVMI in both the surgery (63.0±18.1 to 55.3±19.5 g/m2.7, P<0.001) and drug treatment (56.8±14.1 to 52.1±13.5 g/m2.7, P<0.001) groups. Our results suggest the autonomous aldosterone secretion level, not the basal aldosterone level itself, is relevant to LVH in patients with PA. In addition, the elevated LVMI seen in patients with PA is at least partially reversible with surgical or medical treatment.

Methodological quality

Publication Type : Multicenter Study ; Observational Study

Metadata

MeSH terms : Aldosterone ; Renin