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Volume overload is a major characteristic in primary aldosteronism: a 3-year follow-up study

Eeva Kokko1, Manoj Kumar Choudhary1, Aapo Mutanen1

  • 1Faculty of Medicine and Health Technology, Tampere University.

Journal of Hypertension
|February 26, 2024
PubMed

Insights

Primary aldosteronism causes excess extracellular water, increasing forward wave amplitude. Targeted treatment normalized volume load and improved hemodynamics, suggesting extracellular water evaluation aids diagnosis.

Area of Science:

  • Cardiovascular Physiology
  • Endocrinology
  • Hypertension Research

Background:

  • Primary aldosteronism is characterized by excessive aldosterone production, leading to hypertension.
  • Hemodynamic alterations, including volume balance and wave propagation, are critical in primary aldosteronism.
  • Essential hypertension shares some hemodynamic similarities but differs in volume status.

Purpose of the Study:

  • To investigate hemodynamic changes, specifically volume balance and wave amplitudes, in primary aldosteronism before and after treatment.
  • To compare these hemodynamic profiles with essential hypertension and normotensive individuals.
  • To identify factors influencing hemodynamic improvements following primary aldosteronism treatment.

Main Methods:

  • Radial artery pulse wave analysis and whole-body impedance cardiography were used for hemodynamic recordings.
  • Primary aldosteronism was treated via adrenalectomy (unilateral) or spironolactone (bilateral).
  • Essential hypertension was managed with standard antihypertensive agents.

Main Results:

  • Primary aldosteronism patients exhibited significant extracellular water excess (approximately 10%) compared to other groups, which normalized post-treatment.
  • Both primary aldosteronism and essential hypertension showed elevated aortic blood pressure, wave amplitudes, and systemic vascular resistance.
  • Treatment effectively reduced these hemodynamic variables, with decreased systemic vascular resistance and extracellular water volume significantly impacting forward wave amplitude reduction.

Conclusions:

  • The primary hemodynamic distinction in primary aldosteronism is an elevated volume load, contributing to increased forward wave amplitude.
  • Targeted treatment of primary aldosteronism normalizes volume load and improves hemodynamic parameters.
  • Routine assessment of extracellular water may improve the identification and diagnosis of primary aldosteronism.
Abstract

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