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Left ventricular hypertrophy precedes other target-organ damage in primary aldosteronism
Y Shigematsu1, M Hamada, H Okayama
1The Second Department of Internal Medicine, Ehime, University School of Medicine, Shige-nobu-cho, Onsen-gun, Japan.
Insights
Primary aldosteronism causes significant left ventricular hypertrophy with less extracardiac target-organ damage compared to essential hypertension. This suggests volume overload from aldosteronism leads to different organ damage patterns.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- Primary aldosteronism and essential hypertension are common causes of elevated blood pressure.
- Both conditions can lead to target-organ damage, but the patterns may differ.
Purpose of the Study:
- To compare the progression of target-organ damage, specifically left ventricular hypertrophy and extracardiac damage, between primary aldosteronism and essential hypertension.
Main Methods:
- A comparative study involving 23 patients with primary aldosteronism and 116 patients with essential hypertension.
- Assessment of left ventricular hypertrophy and extracardiac target-organ damage, including hypertensive retinopathy and renal involvement.
Main Results:
- Primary aldosteronism showed marked left ventricular hypertrophy with milder extracardiac target-organ damage compared to essential hypertension with left ventricular hypertrophy.
- Left ventricular end-diastolic dimension index was significantly larger in primary aldosteronism.
- Eccentric left ventricular hypertrophy did not differ in extracardiac damage between primary aldosteronism and essential hypertension groups.
Conclusions:
- Volume overload in primary aldosteronism may lead to eccentric left ventricular hypertrophy with less extracardiac damage than concentric hypertrophy seen in essential hypertension.
- Different mechanisms of left ventricular hypertrophy influence the extent and type of target-organ damage.
Abstract:
To elucidate whether there is a difference in the progression of target-organ damage between primary aldosteronism and essential hypertension, we compared left ventricular hypertrophy and extracardiac target-organ damage in 23 patients with primary aldosteronism and 116 patients with essential hypertension. The severity of hypertensive retinopathy and the renal involvement in primary aldosteronism were subclinical and similar to those in essential hypertension without left ventricular hypertrophy but significantly milder than those in essential hypertension with left ventricular hypertrophy. There was a strongly significant correlation between the degree of left ventricular mass index and the severity of hypertensive retinopathy and renal involvement independent of office blood pressure in essential hypertension. In contrast, left ventricular hypertrophy markedly progressed despite the mild extracardiac target-organ damage in primary aldosteronism. Left ventricular end-diastolic dimension index in primary aldosteronism (3.16+/-0.50 cm/m2) was significantly larger than in essential hypertension without (2.87+/-0.23) and with (2.88+/-0.22) left ventricular hypertrophy. On the other hand, there was no difference in extracardiac target-organ damage between 13 primary aldosteronism patients with eccentric left ventricular hypertrophy and the 26 essential hypertensive patients with eccentric left ventricular hypertrophy. The results suggest that predominantly volume load, be it due to aldosteronism or other mechanisms, resulting in eccentric left ventricular hypertrophy is less likely to cause extracardiac target-organ damage than hemodynamic or nonhemodynamic mechanisms resulting in concentric left ventricular hypertrophy.