Larger ascending aorta in primary aldosteronism: a 3-year prospective evaluation of adrenalectomy vs. medical treatment
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Primary aldosteronism is associated with higher cardiovascular morbidity as compared with essential hypertension. Vascular complications encompass myocardial infarction and cerebrovascular events. Aortic damage in primary aldosteronism has never been explored, although a few cases of ascending aorta aneurisms have been reported.
Design and methods
We consecutively enrolled patients affected by primary aldosteronism (n = 45) and compared them with patients affected by essential hypertension (n = 47), on an outpatient setting. Echocardiographic data of patients with primary aldosteronism were collected during a mean follow-up of 3 years, in subjects who underwent adrenal surgery (n = 12) and those on mineralocorticoid receptor antagonists (n = 33).
Results and conclusion
We found that patients with primary aldosteronism had larger ascending aorta diameters than those with essential hypertension before starting any specific treatment. Patients with primary aldosteronism did not show significant changes in the size of ascending aorta during a mean of 3 years of follow-up, irrespective of the type of treatment (medical vs. surgical treatment). A longer follow-up will better clarify if worsening of the aortic damage may be better prevented by surgery rather than by mineralocorticoid receptor antagonists.
KeywordsPrimary aldosteronism Ascending aorta Aortic root Aortic aneurysm Aldosterone Adrenal cortex
hypertensive control patients with nonsecreting adrenal adenoma
left ventricular hypertrophy
This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.
The authors equally contributed in writing the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 6.S. Monticone, F. D’Ascenzo, C. Moretti et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 6(1), 41–50 (2018). https://doi.org/10.1016/S2213-8587(17)30319-4 CrossRefGoogle Scholar
- 7.G.P. Rossi, G. Bernini, G. Desideri, B. Fabris, C. Ferri, G. Giacchetti, C. Letizia, M. Maccario, M. Mannelli, M. Matterello, D. Montemurro, G. Palumbo, D. Rizzoni, E. Rossi, A.C. Pessina, F. Mantero, Renal damage in primary aldosteronism: results of the PAPY Study. Hypertension 48(2), 232–238 (2006)CrossRefGoogle Scholar
- 9.M. Reincke, E. Fischer, S. Gerum, K. Merkle, S. Schulz, A. Pallauf, M. Quinkler, G. Hanslik, K. Lang, S. Hahner, B. Allolio, C. Meisinger, R. Holle, F. Beuschlein, M. Bidlingmaier, S. Endres, Observational study mortality in treated primary aldosteronism: the German Conn’s registry. Hypertension 60(3), 618–624 (2012)CrossRefGoogle Scholar
- 16.J. Widimsky Jr., B. Strauch, O. Petrák, J. Rosa, Z. Somloova, T. Zelinka, R. Holaj. Vascular disturbances in primary aldosteronism: clinical evidence. Kidney Blood Press. Res. 529–533 (2012). https://doi.org/10.1159/000340031
- 17.N. López Andrés, A. Tesse, V. Regnault, H. Louis, V. Cattan, S.N. Thornton, C. Labat, A. Kakou, S. Tual-Chalot, S. Faure, P. Challande, M. Osborne-Pellegrin, M.C. Martinez, P. Lacolley, R. Andriantsitohaina, Increased microparticle production and impaired microvascular endothelial function in aldosterone-salt-treated rats: protective effects of polyphenols. PLoS One 7(7), e39235 (2012)CrossRefGoogle Scholar
- 21.M. Podgórski, A. Derkacz, R. Poręba, K. Belowska-Bień, K. Gruber, A. Szuba, R. Andrzejak, Aortic dissection—a rare complication of primary aldosteronism—a case report. Kardiol. Pol. 69(2), 156–158 (2011). discussion 159Google Scholar
- 23.Y. Ito, K. Yoshimura, Y. Matsuzawa, J. Saito, H. Ito, H. Furukawa, K. Okura, M. Fukata, T. Konishi, T. Nishikawa, Successful treatment of a mycotic aortic pseudoaneurysm in a patient with type 2 diabetes mellitus while treating primary aldosteronism with spironolactone. J. Atheroscler. Thromb. 17, 771–775 (2010). [cited 13 November 2014]CrossRefGoogle Scholar
- 24.R.M. Lang, M. Bierig, R.B. Devereux, F.A. Flachskampf, E. Foster, P.A. Pellikka, M.H. Picard, M.J. Roman, J. Seward, J.S. Shanewise, Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J. Am. Soc. Echocardiogr. 18, 1440–1463 (2005)CrossRefGoogle Scholar
- 28.V. Palmieri, J.N. Bella, D.K. Arnett, M.J. Roman, A. Oberman, D.W. Kitzman, P.N. Hopkins, M. Paranicas, D.C. Rao, R.B. Devereux, Aortic root dilatation at sinuses of valsalva and aortic regurgitation in hypertensive and normotensive subjects: the Hypertension Genetic Epidemiology Network Study. Hypertension 37(5), 1229–1235 (2001)CrossRefGoogle Scholar
- 29.Erbel R., Eggebrecht H. Aortic dimensions and the risk of dissection. Heart. (2006) https://doi.org/10.1136/hrt.2004.055111.
- 30.J.W. Funder, R.M. Carey, C. Fardella, C.E. Gomez-Sanchez, F. Mantero, M. Stowasser, J.W.F. Young, V.M. Montori, Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 93(9), 3266–3281 (2008)CrossRefGoogle Scholar
- 31.G. Di Dalmazi, V. Vicennati, E. Rinaldi, A.M. Morselli-Labate, E. Giampalma, C. Mosconi, U. Pagotto, R. Pasquali, Progressively increased patterns of subclinical cortisol hypersecretion in adrenal incidentalomas differently predict major metabolic and cardiovascular outcomes: a large cross-sectional study. Eur. J. Endocrinol. 166(4), 669–677 (2012)CrossRefGoogle Scholar
- 35.G. Mancia, R. Fagard, K. Narkiewicz, J. Redon, A. Zanchetti, M. Böhm, T. Christiaens, R. Cifkova, G. De Backer, A. Dominiczak, M.E. Galderisi, D. Grobbee, T. Jaarsma, P.E. Kirchhof, S. Kjeldsen, S.J. Laurent, A.M. Manolis, P. Nilsson, L.M. Ruilope, R. E. Schmieder, P.A. Sirnes, P. Sleight, M. Viigima, B. Waeber, F. Zannad, 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur. Heart J. 34(28), 2159–2219 (2013)CrossRefGoogle Scholar
- 36.S. Buckvold, A.T. Yetman, L.F. Hiratzka, G.L. Bakris, J.A. Beckman, R.M. Bersin et al.. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, A. Circulation 121, e266–e369 (2010)Google Scholar
- 39.J.-M. Tartière, L. Kesri, J.-J. Mourad, M. Safar, J. Blacher, Primary aldosteronism. A risk factor for aortic dissection? J. Mal. Vasc. 28(4), 185–189 (2003)Google Scholar