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Pillai K, Fares A, Dargham S, Al Suwaidi J, Jayyousi A, Abi Khalil C. Primary hyperaldosteronism is associated with increased mortality and morbidity in patients with hypertension and diabetes. Front Endocrinol (Lausanne) 2023; 14:1147225. [PMID: 37305032 PMCID: PMC10250736 DOI: 10.3389/fendo.2023.1147225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
Aims Primary hyperaldosteronism (PA) is a common cause of hypertension. It is more prevalent in patients with diabetes. We assessed the cardiovascular impact of PA in patients with established hypertension and diabetes. Methods Data from the National Inpatient Sample (2008-2016) was used to identify adults with PA with hypertension and diabetes comorbidities and then compared to non-PA patients. The primary outcome was in-hospital death. Secondary outcomes included ischemic stroke, hemorrhagic stroke, acute renal failure, atrial fibrillation, and acute heart failure. Results A total of 48,434,503 patients with hypertension and diabetes were included in the analysis, of whom 12,850 (0.03%) were diagnosed with primary hyperaldosteronism (PA). Compared to patients with hypertension and diabetes but no PA, those with PA were more likely to be younger [63(13) vs. 67 (14), male (57.1% vs. 48.3%), and African-Americans (32% vs. 18.5%) (p<0.001 for all). PA was associated with a higher risk of mortality (adjusted OR 1.076 [1.076-1.077]), ischemic stroke [adjusted OR 1.049 (1.049-1.05)], hemorrhagic stroke [adjusted OR 1.05 (1.05-1.051)], acute renal failure [adjusted OR 1.058 (1.058-1.058)], acute heart failure [OR 1.104 (1.104-1.104)], and atrial fibrillation [adjusted OR 1.034 (1.033-1.034)]. As expected, older age and underlying cardiovascular disease were the strongest predictors of mortality. However, the female gender conferred protection [OR 0.889 (0.886-0.892]. Conclusion Primary hyperaldosteronism in patients with hypertension and diabetes is associated with increased mortality and morbidity.
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Affiliation(s)
| | - Ahmed Fares
- Department of Medicine, Weill Cornell Medicine–Qatar, Doha, Qatar
| | - Soha Dargham
- Biostatistics Core, Weill Cornell Medicine–Qatar, Doha, Qatar
| | | | - Amin Jayyousi
- Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Charbel Abi Khalil
- Department of Medicine, Weill Cornell Medicine–Qatar, Doha, Qatar
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, United States
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Ye D, Wu C, Chen H, Liang CL, Howatt DA, Franklin MK, Moorleghen JJ, Tyagi SC, Uijl E, Danser AHJ, Sawada H, Daugherty A, Lu HS. Fludrocortisone Induces Aortic Pathologies in Mice. Biomolecules 2022; 12:825. [PMID: 35740952 PMCID: PMC9220881 DOI: 10.3390/biom12060825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE In an experiment designed to explore the mechanisms of fludrocortisone-induced high blood pressure, we serendipitously observed aortic aneurysms in mice infused with fludrocortisone. The purpose of this study was to investigate whether fludrocortisone induces aortic pathologies in both normocholesterolemic and hypercholesterolemic mice. METHODS AND RESULTS Male adult C57BL/6J mice were infused with either vehicle (85% polyethylene glycol 400 (PEG-400) and 15% dimethyl sulfoxide (DMSO); n = 5) or fludrocortisone (12 mg/kg/day dissolved in 85% PEG-400 and 15% DMSO; n = 15) for 28 days. Fludrocortisone-infused mice had higher systolic blood pressure, compared to mice infused with vehicle. Fludrocortisone induced aortic pathologies in 4 of 15 mice with 3 having pathologies in the ascending and aortic arch regions and 1 having pathology in both the ascending and descending thoracic aorta. No pathologies were noted in abdominal aortas. Subsequently, we infused either vehicle (n = 5/group) or fludrocortisone (n = 15/group) into male ApoE -/- mice fed a normal laboratory diet or LDL receptor -/- mice fed either normal or Western diet. Fludrocortisone increased systolic blood pressure, irrespective of mouse strain or diet. In ApoE -/- mice infused with fludrocortisone, 2 of 15 mice had ascending aortic pathologies, but no mice had abdominal aortic pathologies. In LDL receptor -/- mice fed normal diet, 5 had ascending/arch pathologies and 1 had pathologies in the ascending, arch, and suprarenal aortic regions. In LDL receptor -/- mice fed Western diet, 2 died of aortic rupture in either the descending thoracic or abdominal region, and 2 of the 13 survived mice had ascending/arch aortic pathologies. Aortic pathologies included hemorrhage, wall thickening or thinning, or dilation. Only ascending aortic diameter in LDLR -/- mice fed Western diet reached statistical significance, compared to their vehicle. CONCLUSION Fludrocortisone induces aortic pathologies independent of hypercholesterolemia. As indicated by the findings in mouse studies, people who are taking or have taken fludrocortisone might have an increased risk of aortic pathologies.
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Affiliation(s)
- Dien Ye
- Saha Cardiovascular Research Center, Lexington, KY 40536, USA; (D.Y.); (C.W.); (H.C.); (C.-L.L.); (D.A.H.); (M.K.F.); (J.J.M.); (S.C.T.); (H.S.); (A.D.)
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; (E.U.); (A.H.J.D.)
| | - Congqing Wu
- Saha Cardiovascular Research Center, Lexington, KY 40536, USA; (D.Y.); (C.W.); (H.C.); (C.-L.L.); (D.A.H.); (M.K.F.); (J.J.M.); (S.C.T.); (H.S.); (A.D.)
- Saha Cardiovascular Research Center, Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Hui Chen
- Saha Cardiovascular Research Center, Lexington, KY 40536, USA; (D.Y.); (C.W.); (H.C.); (C.-L.L.); (D.A.H.); (M.K.F.); (J.J.M.); (S.C.T.); (H.S.); (A.D.)
| | - Ching-Ling Liang
- Saha Cardiovascular Research Center, Lexington, KY 40536, USA; (D.Y.); (C.W.); (H.C.); (C.-L.L.); (D.A.H.); (M.K.F.); (J.J.M.); (S.C.T.); (H.S.); (A.D.)
| | - Deborah A. Howatt
- Saha Cardiovascular Research Center, Lexington, KY 40536, USA; (D.Y.); (C.W.); (H.C.); (C.-L.L.); (D.A.H.); (M.K.F.); (J.J.M.); (S.C.T.); (H.S.); (A.D.)
| | - Michael K. Franklin
- Saha Cardiovascular Research Center, Lexington, KY 40536, USA; (D.Y.); (C.W.); (H.C.); (C.-L.L.); (D.A.H.); (M.K.F.); (J.J.M.); (S.C.T.); (H.S.); (A.D.)
| | - Jessica J. Moorleghen
- Saha Cardiovascular Research Center, Lexington, KY 40536, USA; (D.Y.); (C.W.); (H.C.); (C.-L.L.); (D.A.H.); (M.K.F.); (J.J.M.); (S.C.T.); (H.S.); (A.D.)
| | - Samuel C. Tyagi
- Saha Cardiovascular Research Center, Lexington, KY 40536, USA; (D.Y.); (C.W.); (H.C.); (C.-L.L.); (D.A.H.); (M.K.F.); (J.J.M.); (S.C.T.); (H.S.); (A.D.)
- Saha Cardiovascular Research Center, Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
- Department of Physiology, University of Kentucky, Lexington, KY 40536, USA
- Saha Aortic Center, University of Kentucky, Lexington, KY 40536, USA
| | - Estrellita Uijl
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; (E.U.); (A.H.J.D.)
| | - A. H. Jan Danser
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; (E.U.); (A.H.J.D.)
| | - Hisashi Sawada
- Saha Cardiovascular Research Center, Lexington, KY 40536, USA; (D.Y.); (C.W.); (H.C.); (C.-L.L.); (D.A.H.); (M.K.F.); (J.J.M.); (S.C.T.); (H.S.); (A.D.)
- Department of Physiology, University of Kentucky, Lexington, KY 40536, USA
- Saha Aortic Center, University of Kentucky, Lexington, KY 40536, USA
| | - Alan Daugherty
- Saha Cardiovascular Research Center, Lexington, KY 40536, USA; (D.Y.); (C.W.); (H.C.); (C.-L.L.); (D.A.H.); (M.K.F.); (J.J.M.); (S.C.T.); (H.S.); (A.D.)
- Department of Physiology, University of Kentucky, Lexington, KY 40536, USA
- Saha Aortic Center, University of Kentucky, Lexington, KY 40536, USA
| | - Hong S. Lu
- Saha Cardiovascular Research Center, Lexington, KY 40536, USA; (D.Y.); (C.W.); (H.C.); (C.-L.L.); (D.A.H.); (M.K.F.); (J.J.M.); (S.C.T.); (H.S.); (A.D.)
- Department of Physiology, University of Kentucky, Lexington, KY 40536, USA
- Saha Aortic Center, University of Kentucky, Lexington, KY 40536, USA
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Bollati M, Lopez C, Bioletto F, Ponzetto F, Ghigo E, Maccario M, Parasiliti-Caprino M. Atrial Fibrillation and Aortic Ectasia as Complications of Primary Aldosteronism: Focus on Pathophysiological Aspects. Int J Mol Sci 2022; 23:2111. [PMID: 35216224 PMCID: PMC8875197 DOI: 10.3390/ijms23042111] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 11/22/2022] Open
Abstract
Primary aldosteronism (PA) is the most common cause of secondary hypertension. A growing body of evidence has suggested that, beyond its well-known effects on blood pressure and electrolyte balance, aldosterone excess can exert pro-inflammatory, pro-oxidant and pro-fibrotic effects on the kidney, blood vessels and heart, leading to potentially harmful pathophysiological consequences. In clinical studies, PA has been associated with an increased risk of cardiovascular, cerebrovascular, renal and metabolic complication compared to essential hypertension, including atrial fibrillation (AF) and aortic ectasia. An increased prevalence of AF in patients with PA has been demonstrated in several clinical studies. Aldosterone excess seems to be involved in the pathogenesis of AF by inducing cardiac structural and electrical remodeling that in turn predisposes to arrhythmogenicity. The association between PA and aortic ectasia is less established, but several studies have demonstrated an effect of aldosterone on aortic stiffness, vascular smooth muscle cells and media composition that, in turn, might lead to an increased risk of aortic dilation and dissection. In this review, we focus on the current evidence regarding the potential role of aldosterone excess in the pathogenesis of AF and aortic ectasia.
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Affiliation(s)
| | | | | | | | | | | | - Mirko Parasiliti-Caprino
- Endocrinology, Diabetes and Metabolism, City of Health and Science University Hospital, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (M.B.); (C.L.); (F.B.); (F.P.); (E.G.); (M.M.)
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Prevalence of primary aldosteronism and association with cardiovascular complications in patients with resistant and refractory hypertension. J Hypertens 2021; 38:1841-1848. [PMID: 32384388 DOI: 10.1097/hjh.0000000000002441] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the prevalence of primary aldosteronism and its association with cardiometabolic complications in patients with resistant and refractory hypertension. METHODS One hundred and ten consecutive patients with true resistant hypertension [insufficient blood pressure control despite appropriate lifestyle measures and treatment with at least three classes of antihypertensive medication, including a diuretic] and without previous cardiovascular events were screened for secondary hypertension. Refractory hypertension was diagnosed in case of uncontrolled blood pressure despite the use of at least five antihypertensive drugs. RESULTS Primary aldosteronism was diagnosed in 32 cases (29.1%). The multivariate analysis showed that primary aldosteronism is a strong factor positively associated with left ventricular hypertrophy [odds ratio (OR) = 12.98, 95% confidence interval (CI) 3.82-60.88; P < 0.001], microalbuminuria (OR = 3.67, 95% CI 1.44-9.78; P = 0.007), carotid intima-media thickness at least 0.9 mm (OR = 2.69, 95% CI 1.02-7.82; P = 0.037), aortic ectasia (OR = 4.08, 95% CI 1,18-15.04; P = 0.027) and atrial fibrillation (OR 8.80, 95% CI 1.53-73.98; P = 0.022). Moreover, primary aldosteronism was independently associated with the presence of at least one (OR = 8.60, 95% CI 1.73-69.88; P = 0.018) and at least two types of organ damage (OR = 3.08, 95% CI 1.19-8.24; P = 0.022). Thirteen patients (11.8%) were affected by refractory hypertension. This group was characterized by significantly higher values of carotid intima-media thickness, higher rate of aldosterone-producing adenoma and atrial fibrillation, compared with the other individuals with resistant hypertension. CONCLUSION The current study indicates that primary aldosteronism is a frequent cause of secondary hypertension and cardiovascular complications among patients with resistant and refractory hypertension, suggesting a crucial role of aldosterone in the pathogenesis of severe hypertensive phenotypes and cardiovascular disease.
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Zhang Y, Luo F, Fan P, Meng X, Yang K, Zhou X. Is primary aldosteronism a potential risk factor for aortic dissection? A case report and literature review. BMC Endocr Disord 2020; 20:115. [PMID: 32736558 PMCID: PMC7393824 DOI: 10.1186/s12902-020-00601-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/22/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Primary aldosteronism (PA) increases the risk of cardiovascular morbidity, including stroke, coronary artery disease, atrial fibrillation, and heart failure. The relationship between primary aldosteronism and aortic dissection has rarely been reported. We report a case of aortic dissection caused by secondary hypertension from PA and review similar cases in the literature. CASE PRESENTATION A 56-year-old woman with a history of surgery for aortic dissection presented for follow-up of hypertension and a left adrenal mass. She had been diagnosed with hypertension and hypokalemia in 2003. Blood pressure had been controlled by antihypertensive medications. In 2009, she presented with chest and back pain; she was diagnosed with aortic dissection by computed tomography (CT). She underwent placement of an endovascular aortic stent graft. CT at that time showed a left adrenal mass with a diameter of 1 cm. In 2017, CT reexamination revealed that the left adrenal mass had grown to 3 cm in diameter. Laboratory data showed blood potassium 2.4 mmol/L (reference range: 3.5-5.3 mmol/L). The plasma aldosterone/renin ratio was elevated because of suppressed plasma renin and elevated serum aldosterone levels. Plasma aldosterone levels were not suppressed after taking captopril. Positron emission tomography/CT showed that the left adrenal tumor radiographic uptake was slightly increased (maximum standardized uptake value of 2.2), and metastasis was not detected. Laparoscopic adrenalectomy was performed, and an adrenocortical adenoma was confirmed histopathologically. After surgery, blood pressure and laboratory findings were within their reference ranges without any pharmacological treatment. CONCLUSIONS Our patient and the literature suggest that PA is a potential cause of aortic dissection. Diagnosing PA in the early stages of the disease and early treatment are important because affected patients may be at increased risk of aortic dissection.
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Affiliation(s)
- Ying Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China
| | - Fang Luo
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China.
| | - Peng Fan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China
| | - Xu Meng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China
| | - Kunqi Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China
| | - Xianliang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China
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Abstract
Abdominal aortic aneurysms (AAA) pose a considerable health burden and at present are only managed surgically since there is no proven pharmacotherapy that will retard their expansion or reduce the incidence of fatal rupture. This pathology shares several pathophysiological mechanisms with atherosclerosis, such as macrophage infiltration, inflammation, and degradation of extracellular matrix. Therefore, therapeutic targets proven effective in the treatment of atherosclerosis could also be considered for treatment of AAA. Different members of the nuclear receptor (NR) superfamily have been extensively studied as potential targets in the treatment of cardiovascular disease (CVD) and therefore might also be suited for AAA treatment. In this context, this review summarizes the role of different NRs in CVD, mostly atherosclerosis, and discusses in detail the current knowledge of their implications in AAA. From this overview it becomes apparent that NRs that were attributed a beneficial or adverse role in CVD have similar roles in AAA. Together, this overview provides compelling evidence to consider several NRs as attractive targets for future treatment of AAA.
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