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Varadarajan V, Marques MD, Venkatesh BA, Allison M, Ostovaneh MR, Yoneyama K, Donekal S, Shah RV, Murthy VL, Wu CO, Tracy RP, Ouyang P, Rochitte CE, Bluemke DA, Lima JAC. Cardiovascular Interactions of Renin-Angiotensin-Aldosterone System Assessed by Cardiac Magnetic Resonance: The Multi-Ethnic Study of Atherosclerosis. Am J Hypertens 2023; 36:517-523. [PMID: 37208017 PMCID: PMC10403971 DOI: 10.1093/ajh/hpad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND The effects of the renin-angiotensin-aldosterone system in cardiovascular system have been described based on small studies. The aim of this study was to evaluate the relationship between aldosterone and plasma renin activity (PRA) and cardiovascular structure and function. METHODS We studied a random sample of Multi-Ethnic Study of Atherosclerosis participants who had aldosterone and PRA blood assays at 2003-2005 and underwent cardiac magnetic resonance at 2010. Participants taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were excluded. RESULTS The aldosterone group was composed by 615 participants, mean age 61.6 ± 8.9 years, while the renin group was 580 participants, mean age 61.5 ± 8.8 years and both groups had roughly 50% females. In multivariable analysis, 1 SD increment of log-transformed aldosterone level was associated with 0.07 g/m2 higher left ventricle (LV) mass index (P = 0.04) and 0.11 ml/m2 higher left atrium (LA) minimal volume index (P < 0.01). Additionally, higher log-transformed aldosterone was associated with lower LA maximum strain and LA emptying fraction (P < 0.01). Aldosterone levels were not significantly associated with aortic measures. Log-transformed PRA was associated with lower LV end diastolic volume index (β standardized = 0.08, P = 0.05). PRA levels were not significantly associated with LA and aortic structural or functional differences. CONCLUSIONS Higher levels of aldosterone and PRA are associated with concentric LV remodeling changes. Moreover, aldosterone was related to deleterious LA remodeling changes.
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Affiliation(s)
| | - Mateus D Marques
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil
| | | | - Matthew Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Mohammad R Ostovaneh
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Kihei Yoneyama
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Sirisha Donekal
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ravi V Shah
- Cardiovascular Division, Brigham & Women’s Hospital, Boston, Massachusetts, USA
| | - Venkatesh L Murthy
- Department of Internal Medicine, University of Michigan Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Colin O Wu
- Office of Biostatistics Research, NHLBI, NIH, Bethesda, Maryland, USA
| | - Russell P Tracy
- Department of Pathology, University of Vermont, Colchester, Vermont, USA
| | - Pamela Ouyang
- Clinical Research Unit, Johns Hopkins Medical Institutes, Baltimore, Maryland, USA
| | - Carlos E Rochitte
- Heart Institute, University of Sao Paulo Medical School, São Paulo, Brazil
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Joao A C Lima
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
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Chen ZW, Pan CT, Liao CW, Tsai CH, Chang YY, Chang CC, Lee BC, Chiu YW, Huang WC, Wang SM, Lu CC, Chueh JS, Wu VC, Hung CS, Lin YH. Implication of MR Activity in Posttreatment Arterial Stiffness Reversal in Patients With Primary Aldosteronism. J Clin Endocrinol Metab 2023; 108:624-632. [PMID: 36333943 DOI: 10.1210/clinem/dgac649] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT Primary aldosteronism (PA) patients have a higher degree of arterial stiffness, which can be reversed after adrenalectomy. OBJECTIVE We aimed to compare the reversal of arterial stiffness between surgically and medically treated PA patients and to identify the predictors of effective medical treatment. METHODS We prospectively enrolled 445 PA patients and collected data on baseline clinical characteristics, biochemistry, blood pressure, and pulse wave velocity (PWV) before treatment and 12 months after treatment. In the mineralocorticoid receptor antagonist (MRA)-treated patients, the relationship between the change in PWV after 1 year (ΔPWV) and posttreatment renin activity was explored using the restricted cubic spline (RCS) method. RESULTS Of the 445 enrolled PA patients, 255 received adrenalectomy (group 1) and 190 received MRAs. In the RCS model, posttreatment plasma renin activity (PRA) 1.5 ng/mL/h was the best cutoff value. Therefore, we divided the MRA-treated patients into 2 groups: those with suppressed PRA (< 1.5 ng/mL/h, group 2), and those with unsuppressed PRA (≥ 1.5 ng/mL/h, group 3). Only group 1 and group 3 patients had a statistically significant improvement in PWV after treatment (both P < .001), whereas no significant improvement was noted in group 2 after treatment (P = .151). In analysis of variance and post hoc analysis, group 2 had a significantly lower ΔPWV than group 1 (P = .007) and group 3 (P = .031). Multivariable regression analysis of the MRA-treated PA patients identified log-transformed posttreatment PRA, age, and baseline PWV as independent factors correlated with ΔPWV. CONCLUSION The reversal of arterial stiffness was found in PA patients receiving adrenalectomy and in medically treated PA patients with unsuppressed PRA.
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Affiliation(s)
- Zheng-Wei Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin 640, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chien-Ting Pan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin 640, Taiwan
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
- Department of Medicine, National Taiwan University Cancer Center, Taipei 106, Taiwan
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City 208, Taiwan
| | - Yi-Yao Chang
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Yu-Wei Chiu
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan City 320, Taiwan
| | - Wei-Chieh Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Shuo-Meng Wang
- Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Ching-Chu Lu
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Jeff S Chueh
- Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
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3
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Wu T, Ren Y, Wang W, Cheng W, Zhou F, He S, Liu X, Li L, Tang L, Deng Q, Zhou X, Chen Y, Sun J. Left Ventricular Remodeling in Patients with Primary Aldosteronism: A Prospective Cardiac Magnetic Resonance Imaging Study. Korean J Radiol 2021; 22:1619-1627. [PMID: 34269528 PMCID: PMC8484156 DOI: 10.3348/kjr.2020.1291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/07/2021] [Accepted: 04/25/2021] [Indexed: 02/05/2023] Open
Abstract
Objective This study used cardiac magnetic resonance imaging (MRI) to compare the characteristics of left ventricular remodeling in patients with primary aldosteronism (PA) with those of patients with essential hypertension (EH) and healthy controls (HCs). Materials and Methods This prospective study enrolled 35 patients with PA, in addition to 35 age- and sex-matched patients with EH, and 35 age- and sex-matched HCs, all of whom underwent comprehensive clinical and cardiac MRI examinations. The analysis of variance was used to detect the differences in the characteristics of left ventricular remodeling among the three groups. Univariable and multivariable linear regression analyses were used to determine the relationships between left ventricular remodeling and the physiological variables. Results The left ventricular end-diastolic volume index (EDVi) (mean ± standard deviation [SD]: 85.1 ± 13.0 mL/m2 for PA, 75.9 ± 14.3 mL/m2 for EH, and 77.3 ± 12.8 mL/m2 for HC; p = 0.010), left ventricular end-systolic volume index (ESVi) (mean ± SD: 35.2 ± 9.8 mL/m2 for PA, 30.7 ± 8.1 mL/m2 for EH, and 29.5 ± 7.0 mL/m2 for HC; p = 0.013), left ventricular mass index (mean ± SD: 65.8 ± 16.5 g/m2 for PA, 56.9 ± 12.1 g/m2 for EH, and 44.1 ± 8.9 g/m2 for HC; p < 0.001), and native T1 (mean ± SD: 1224 ± 39 ms for PA, 1201 ± 47 ms for EH, and 1200 ± 44 ms for HC; p = 0.041) values were higher in the PA group compared to the EH and HC groups. Multivariable linear regression demonstrated that log (plasma aldosterone-to-renin ratio) was independently correlated with EDVi and ESVi. Plasma aldosterone was independently correlated with native T1. Conclusion Patients with PA showed a greater degree of ventricular hypertrophy and enlargement, as well as myocardial fibrosis, compared to those with EH. Cardiac MRI T1 mapping can detect left ventricular myocardial fibrosis in patients with PA.
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Affiliation(s)
- Tao Wu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Ren
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Wang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Cheng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fangli Zhou
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Shuai He
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiumin Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiao Deng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyue Zhou
- Department of North Sichuan Medical College, Nanchong, China
| | - Yucheng Chen
- Department of MR Collaboration, Siemens Healthcare, Shanghai, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
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Choudhary MK, Värri E, Matikainen N, Koskela J, Tikkakoski AJ, Kähönen M, Niemelä O, Mustonen J, Nevalainen PI, Pörsti I. Primary aldosteronism: Higher volume load, cardiac output and arterial stiffness than in essential hypertension. J Intern Med 2021; 289:29-41. [PMID: 32463949 DOI: 10.1111/joim.13115] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/05/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The diagnostics of primary aldosteronism (PA) are usually carried out in patients taking antihypertensive medications. We compared haemodynamics between medicated PA, medicated essential hypertension (EH), never-medicated EH and normotensive controls (n = 130 in all groups). METHODS The hypertensive groups were matched for age (53 years), sex (84 male/46 female) and body mass index (BMI) (30 kg m-2 ); normotensive controls had similar sex distribution (age 48 years, BMI 27 kg m-2 ). Haemodynamics were recorded using whole-body impedance cardiography and radial pulse wave analysis, and the results were adjusted as appropriate. Radial blood pressure recordings were calibrated by brachial blood pressure measurements from the contralateral arm. RESULTS Radial and aortic systolic and diastolic blood pressure was similar in PA and never-medicated EH, and higher than in medicated EH and normotensive controls (P ≤ 0.001 for all comparisons). Extracellular water balance was ~ 4% higher in PA than in all other groups (P < 0.05 for all), whilst cardiac output was ~ 8% higher in PA than in medicated EH (P = 0.012). Systemic vascular resistance and augmentation index were similarly increased in PA and both EH groups when compared with controls. Pulse wave velocity was higher in PA and never-medicated EH than in medicated EH and normotensive controls (P ≤ 0.033 for all comparisons). CONCLUSIONS Medicated PA patients presented with corresponding systemic vascular resistance and wave reflection, but higher extracellular water volume, cardiac output and arterial stiffness than medicated EH patients. Whether the systematic evaluation of these features would benefit the clinical diagnostics of PA remains to be studied in future.
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Affiliation(s)
- M K Choudhary
- From the, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - E Värri
- From the, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - N Matikainen
- Endocrinology, Helsinki University Hospital and Research Programs Unit, Clinical and Molecular Medicine, University of Helsinki, Helsinki, Finland
| | - J Koskela
- From the, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - A J Tikkakoski
- From the, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - M Kähönen
- From the, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - O Niemelä
- From the, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Laboratory and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - J Mustonen
- From the, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - P I Nevalainen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - I Pörsti
- From the, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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5
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Hung CS, Sung SH, Liao CW, Pan CT, Chang CC, Chen ZW, Wu VC, Chen CH, Cheng HM, Lin YH. Aldosterone Induces Vascular Damage. Hypertension 2019; 74:623-629. [PMID: 31352825 DOI: 10.1161/hypertensionaha.118.12342] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Primary aldosteronism (PA) is hemodynamically independently associated with arterial wall stiffness as assessed by pulse wave velocity (PWV) compared with essential hypertension. Arterial wave reflection parameters derived from pulse wave analysis, such as forward and backward wave amplitudes (Pf and Pb), are promising vascular markers to predict cardiovascular outcomes in addition to PWV. These vascular parameters have never been studied in patients with PA before. In study part A, we prospectively enrolled 67 patients with PA and 132 patients with essential hypertension. In study part B, another 54 patients with PA were enrolled. Heart-carotid PWV was measured, and carotid pressure waveforms were recorded to calculate Pf, Pb, and augmentation index at baseline (part A and B) and 6 months after treatment (part B). The results showed that the patients with PA had significantly higher Pf (P=0.001), Pb (P=0.01), and PWV (P=0.021) than the patients with essential hypertension. In univariate correlation analysis, both log Pf and Pb were significantly correlated with age, office blood pressure, serum potassium level, log PWV, and the presence of PA. However, only Pb was significantly correlated with log plasma renin activity and log aldosterone to renin ratio. In multivariate analysis, log Pf was significantly correlated with the presence of PA (P=0.001), male sex, age, and mean arterial blood pressure. Pb was significantly correlated with the presence of PA (P=0.031), age, and mean arterial pressure. Six months after treatment, Pf and Pb decreased significantly. In conclusion, the patients with PA had significantly increased wave reflections compared with the patients with essential hypertension. Our results provide clinical evidence of aldosterone-related extensive vascular dysfunction of the arterial system.
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Affiliation(s)
- Chi-Sheng Hung
- From the Telehealth Center, National Taiwan University Hospital, Taipei (C.-S.H.).,Department of Internal Medicine (C.-S.H., C.-T.P., V.-C.W., Y.-H.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shih-Hsien Sung
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan (S.-H.S.).,Department of Medicine, National Yang-Ming University, Taipei, Taiwan (S.-H.S., C.-H.C., H.-M.C.)
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch (C.-W.L.)
| | - Chien-Ting Pan
- Department of Internal Medicine (C.-S.H., C.-T.P., V.-C.W., Y.-H.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging (C.-C.C.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Zheng-Wei Chen
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch (Z.-W.C.)
| | - Vin-Cent Wu
- Department of Internal Medicine (C.-S.H., C.-T.P., V.-C.W., Y.-H.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan (S.-H.S., C.-H.C., H.-M.C.).,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan (C.-H.C., H.-M.C.).,Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taiwan (C.-H.C., H.-M.C.)
| | - Hao-Min Cheng
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan (S.-H.S., C.-H.C., H.-M.C.).,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan (C.-H.C., H.-M.C.).,Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taiwan (C.-H.C., H.-M.C.)
| | - Yen-Hung Lin
- Department of Internal Medicine (C.-S.H., C.-T.P., V.-C.W., Y.-H.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Izzo JL, Hong M, Hussain T, Osmond PJ. Maintenance of long-term blood pressure control and vascular health by low-dose amiloride-based therapy in hyperaldosteronism. J Clin Hypertens (Greenwich) 2019; 21:1183-1190. [PMID: 31347775 DOI: 10.1111/jch.13597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/07/2019] [Accepted: 05/25/2019] [Indexed: 12/28/2022]
Abstract
Whether aldosterone itself contributes directly to macro- or microcirculatory disease in man or to adverse cardiovascular outcomes is not fully known. We report our long-term single-practice experience in an unusual group of five patients with chronic hyperaldosteronism (HA, including three with glucocorticoid-remediable aldosteronism, GRA) treated with low-dose amiloride (a specific epithelial sodium channel [ENaC] blocker) 5-10 (mean 7) mg daily for 14-28 (mean 20) years. Except for one GRA diagnosed in infancy, all had severe resistant hypertension. In each case, BP was normalized within 1-4 weeks after starting amiloride and office BP's remained well controlled throughout the next two decades. 24-hour ambulatory BP monitoring with pulse wave analysis (cardiac output, vascular resistance, augmentation index, reflection magnitude), regional pulse wave velocities, pulse stiffening ratio, ankle-brachial index, serum creatinine, estimated glomerular filtration rate, and spot urinary albumin:creatinine ratio were measured after a mean of 18 years; all of these indicators were essentially normal. Over two additional years of observation (100 patient-years total), no cardiovascular or renal event occurred. We conclude that long-term ENaC blockade with amiloride can normalize BP and protect macro- and microvascular function in patients with HA. This suggests that either (a) putative vasculopathic effects of aldosterone are mediated via ENaC or (b) aldosterone may not play a direct role in age-dependent vasculopathic changes in humans independent of blood pressure. These findings, coupled with our literature review in both animal and human results, underscore the need for additional studies.
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Affiliation(s)
- Joseph L Izzo
- Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York.,Erie County Medical Center, Buffalo, New York
| | - Michael Hong
- Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York.,Erie County Medical Center, Buffalo, New York
| | - Tanveer Hussain
- Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York.,Erie County Medical Center, Buffalo, New York
| | - Peter J Osmond
- Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York.,Erie County Medical Center, Buffalo, New York
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7
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Izzo JL, Hong M, Hussain T, Osmond PJ. Long-term BP control and vascular health in patients with hyperaldosteronism treated with low-dose, amiloride-based therapy. J Clin Hypertens (Greenwich) 2019; 21:922-928. [PMID: 31169971 DOI: 10.1111/jch.13567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/23/2019] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
Abstract
Whether aldosterone itself contributes directly to macro- or microcirculatory disease in man or to adverse cardiovascular outcomes is not fully known. We report our long-term single-practice experience in 5 patients with chronic hyperaldosteronism (HA, including 3 with glucocorticoid remediable aldosteronism, GRA) treated with low-dose amiloride (a specific epithelial sodium channel [ENaC] blocker) 5-10 (mean 7) mg daily for 14-28 (mean 20) years. Except for 1 GRA diagnosed in infancy, all had severe resistant hypertension. In each case, BP was normal or near-normal within 1-4 weeks after starting amiloride and office BP's were well controlled for 20 years thereafter. Vascular studies and 24-hour ambulatory BP monitoring with pulse wave analysis (cardiac output, vascular resistance, augmentation index, and reflection magnitude) were assessed after a mean of 18 years as were regional pulse wave velocities, pulse stiffening ratio, ankle-brachial index, serum creatinine, estimated glomerular filtration rate, and spot urinary albumin:creatinine ratio. All indicators were completely normal in all patients after 18 years of amiloride, and none had a cardiovascular event during the 20-year mean follow-up. We conclude that long-term ENaC blockade can normalize BP and protect macro- and microvascular function in patients with HA. This suggests that (a) any vasculopathic effects of aldosterone are mediated via ENaC, not MR activation itself, and are fully preventable or reversible with ENaC blockade or (b) aldosterone may not play a major BP-independent role in human macro- and microcirculatory diseases. These and other widely divergent results in the literature underscore the need for additional studies regarding aldosterone, ENaC, and vascular disease.
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Affiliation(s)
- Joseph L Izzo
- Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York.,Erie County Medical Center, Buffalo, New York
| | - Michael Hong
- Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York.,Erie County Medical Center, Buffalo, New York
| | - Tanveer Hussain
- Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York.,Erie County Medical Center, Buffalo, New York
| | - Peter J Osmond
- Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York.,Erie County Medical Center, Buffalo, New York
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8
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Comparisons of microvascular and macrovascular changes in aldosteronism-related hypertension and essential hypertension. Sci Rep 2017; 7:2666. [PMID: 28572599 PMCID: PMC5453943 DOI: 10.1038/s41598-017-02622-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 04/13/2017] [Indexed: 12/21/2022] Open
Abstract
Case-control observational study to evaluate the microvascular and macrovascular changes in patients with hypertension secondary to primary aldosteronism (PA), essential hypertension (EH) and healthy subjects. Measurements of arterial stiffness including augmentation index (AIx) and pulse wave velocity (PWV) were assessed using a TensioClinic arteriograph system. Retinal microcirculation was imaged by a Retinal Vessel Analyzer (RVA) and a non-midriatic camera (Topcon-TRC-NV2000). IMEDOS software analyzed the retinal artery diameter (RAD), retinal vein diameters (RVD) and arteriole-to-venule ratio (AVR) of the vessels coming off the optic disc. Thirty, 39 and 35 patients were included in the PA, EH and control group, respectively. The PA group showed higher PWV values compared only with the control group. The mean brachial and aortic AIx values did not show significant difference between groups. In the PA group, the mean RVD and AVR values were significantly lower than in the EH and control groups, whereas the parameters did not differ between the EH and control groups. In conclusion, AVR appears significantly modified in the PA group compared with the EH group and could represent an early and more reliable indicator of microvascular remodeling.
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9
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Ambrosino P, Lupoli R, Tortora A, Cacciapuoti M, Lupoli GA, Tarantino P, Nasto A, Di Minno MND. Cardiovascular risk markers in patients with primary aldosteronism: A systematic review and meta-analysis of literature studies. Int J Cardiol 2016; 208:46-55. [PMID: 26826789 DOI: 10.1016/j.ijcard.2016.01.200] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/08/2016] [Accepted: 01/15/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVES Several studies reported an increased cardiovascular (CV) morbidity and mortality in patients with primary aldosteronism (PA). We performed a meta-analysis on the impact of PA on major markers of CV risk. METHODS Studies on the relationship between PA and common carotid artery intima-media thickness (CCA-IMT), prevalence of carotid plaques, flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), pulse-wave velocity (PWV), augmentation index (AIx), and ankle-brachial index (ABI) were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. RESULTS 12 case-control studies (445 cases, 472 controls) were included. Compared to subjects with essential hypertension (EH), PA patients showed a higher CCA-IMT (MD: 0.12 mm; 95% CI: 0.09, 0.16; P<0.00001), and a higher aortic-PWV (272 cases and 240 controls, MD: 1.39 m/s; 95% CI: 0.90, 1.87; P<0.00001). In contrast, non-significant differences were found in AIx and AIx normalized to a heart rate of 75 beats per minute (AIx@75). When compared to normotensive subjects, PA patients showed significantly higher CCA-IMT (MD: 0.16 mm; 95% CI: 0.05, 0.27; P=0.004), aortic-PWV (MD: 3.74 m/s; 95% CI: 3.43, 4.05; P<0.00001), AIx@75 (MD: 8.59%; 95% CI: 0.69, 16.50; P=0.03), and a significantly lower FMD (MD: -2.52%; 95% CI: -3.64, -1.40; P<0.0001). Sensitivity and subgroup analyses substantially confirmed our results. Metaregression models showed that male gender, diabetes, and smoking habit impact on the observed results. CONCLUSIONS PA appears significantly associated with markers of subclinical atherosclerosis and CV risk. These findings could help establish more specific CV prevention strategies in this clinical setting.
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Affiliation(s)
- Pasquale Ambrosino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Roberta Lupoli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Anna Tortora
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marianna Cacciapuoti
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gelsy Arianna Lupoli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Paolo Tarantino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Aurelio Nasto
- Department of Surgery, Unit of General Surgery and Oncology, Andrea Tortora Hospital, Pagani, Italy
| | - Matteo Nicola Dario Di Minno
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy; Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
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Catena C, Colussi G, Sechi LA. Treatment of Primary Aldosteronism and Organ Protection. Int J Endocrinol 2015; 2015:597247. [PMID: 26074961 PMCID: PMC4449945 DOI: 10.1155/2015/597247] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 03/31/2015] [Indexed: 12/25/2022] Open
Abstract
Primary aldosteronism is a frequent form of secondary hypertension that had long been considered relatively benign. Experimental and clinical evidence collected in the last two decades, however, has clearly demonstrated that this endocrine disorder is associated with excess cardiovascular and renal complications as compared to essential hypertension. These complications reflect the ability of inappropriate elevation of plasma aldosterone to cause tissue damage beyond that induced by high blood pressure itself, thereby setting the stage for major cardiovascular and renal disease. Because of the impact of elevated aldosterone on organ damage, goals of treatment in patients with primary aldosteronism should not be limited to normalization of blood pressure, and prevention or correction of organ complications is mandatory. Treatment with mineralocorticoid receptor antagonists or unilateral adrenalectomy is the respective options for treatment of idiopathic adrenal hyperplasia or aldosterone-producing adenoma. Last years have witnessed a rapid growth in knowledge concerning the effects of these treatments on cardiovascular and renal protection. This paper is an overview of the cardiovascular and renal complications that occur in patients with primary aldosteronism and a summary of the results that have been obtained in the long term on cardiovascular and renal outcomes with either medical or surgical treatment.
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Affiliation(s)
- Cristiana Catena
- Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, 33100 Udine, Italy
- *Cristiana Catena:
| | - GianLuca Colussi
- Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, 33100 Udine, Italy
| | - Leonardo A. Sechi
- Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, 33100 Udine, Italy
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