Regression of Left Ventricular Hypertrophy in Primary Aldosteronism

Left ventricular hypertrophy (LVH) is frequently identified in patients with primary aldosteronism; determinants of LVH regression after targeted treatment are debated. We assessed LVH prevalence before and after adrenalectomy or mineralocorticoid receptor antagonist (MRA) therapy, identified determinants of LVH regression, and evaluated the relationship between patients' outcomes and cardiac remodeling.

We retrospectively analyzed an international cohort of patients with primary aldosteronism from 36 referral centers in Spain, Italy, and Germany. Echocardiographic recordings were included at baseline and after at least 1 year of targeted treatment. Regression models were applied to identify parameters associated with LVH regression and changes in left ventricular mass index.

Among 1454 patients (mean age, 51 years; 58.7% male) with primary aldosteronism, baseline LVH prevalence was 49.4%. Aldosterone, blood pressure, male sex, number of antihypertensive medications, and diabetes were associated with LVH. Of 473 patients with a follow-up echocardiography, 33.6% underwent adrenalectomy, 61.7% received MRA, and 4.7% were taking MRA postsurgery. After a median follow-up of 51 months, LVH regression was observed in 54.2% of patients (61.9% after adrenalectomy versus 48.6% with MRA treatment; P=0.043), and left ventricular mass index significantly decreased after both surgery and medical therapy. Higher pretreatment blood pressure and aldosterone levels were associated with a lower likelihood of LVH regression, regardless of treatment modality. Complete biochemical success was associated with greater left ventricular mass index reduction at follow-up.

LVH regressed in over half the patients after targeted treatment, with left ventricular mass index decreasing after both adrenalectomy and MRA therapy. Baseline aldosterone levels were associated with LVH regression, independently of blood pressure load.