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Long-term cardio- and cerebrovascular events in patients with primary aldosteronism

Paolo Mulatero1, Silvia Monticone, Chiara Bertello

  • 1MD, Department of Medical Sciences, Division of Internal Medicine and Hypertension, University of Torino, Via Genova 3, 10126 Torino, Italy. paolo.mulatero@unito.it.

The Journal of Clinical Endocrinology and Metabolism
|September 24, 2013
PubMed

Insights

Patients with primary aldosteronism (PA) have significantly higher cardiovascular and cerebrovascular event rates than essential hypertension (EH) patients. Early diagnosis and treatment of PA are crucial for reducing these risks.

Area of Science:

  • Cardiology
  • Endocrinology
  • Hypertension Research

Background:

  • Aldosterone excess in primary aldosteronism (PA) contributes to cardiovascular damage.
  • PA patients face elevated risks of cardiovascular events compared to essential hypertension (EH) patients.

Purpose of the Study:

  • To compare cardiovascular and cerebrovascular event rates between PA and matched EH patients.
  • To investigate event rates in PA subtypes: aldosterone-producing adenoma and bilateral adrenal hyperplasia.

Main Methods:

  • Retrospective case-control study matching 270 PA patients with 810 EH patients (1:3 ratio).
  • Median follow-up of 12 years, comparing event percentages at baseline and during follow-up.
  • Analysis of PA subtypes (adenoma vs. hyperplasia) against matched EH controls.

Main Results:

  • PA patients experienced significantly more cardiovascular events (22.6% vs. 12.7%, P < .001).
  • Higher incidence of total events at diagnosis (14.1% vs. 8.4%, P = .007) and during follow-up (8.5% vs. 4.3%, P = .008) in PA.
  • Stroke, arrhythmias, and new-onset type 2 diabetes were more frequent in PA patients. Age, hypertension duration, SBP, diabetes, and PA diagnosis independently predicted events.

Conclusions:

  • Aldosterone excess directly impacts the cardiovascular system, increasing event risk.
  • Early diagnosis and targeted treatment of PA are vital for mitigating cardiovascular and cerebrovascular complications.
Abstract

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