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Hypertension with primary aldosteronism is associated with increased carotid intima-media thickness and endothelial

Ahmet Demirkiran1,2, Henk Everaars2, Ali Elitok1

  • 1Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Journal of Clinical Hypertension (Greenwich, Conn.)
|June 13, 2019
PubMed

Insights

Patients with primary aldosteronism experience worse vascular health, including thicker carotid arteries and poorer endothelial function, compared to those with essential hypertension. These effects are independent of blood pressure levels.

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Hypertension Research

Background:

  • Patients with primary aldosteronism (PA) and hypertension show increased cardiovascular event risk.
  • Existing data on PA's specific impact on cardiovascular structure and function, independent of hypertension, are conflicting.

Purpose of the Study:

  • To investigate the effects of primary aldosteronism on vascular structure and endothelial function.
  • To differentiate PA's impact from essential hypertension using intima-media thickness and flow-mediated dilation.

Main Methods:

  • Prospective enrollment of 70 patients with resistant hypertension (29 PA, 41 essential hypertension).
  • Ultrasound assessment of common carotid intima-media thickness (CIMT) and brachial artery flow-mediated dilation (FMD).
  • Analysis adjusted for age, sex, diabetes, 24-hour systolic blood pressure, and smoking.

Main Results:

  • Primary aldosteronism patients exhibited significantly lower FMD (3.3% vs 14.7%, P < 0.01) and higher CIMT (0.9 mm vs 0.8 mm, P = 0.02).
  • These differences persisted after adjusting for confounding factors (P < 0.01).
  • No significant differences in CIMT or FMD were found between PA subtypes (adenoma vs. hyperplasia).

Conclusions:

  • Primary aldosteronism adversely affects vascular structure and endothelial function independently of hypertension severity.
  • These findings highlight a distinct pathophysiological mechanism of cardiovascular damage in PA.

Keywords:
aldosteronecarotid intima-media thicknessendothelial dysfunctionflow-mediated dilationhypertensionprimary aldosteronism

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