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Kao TW, Liao CW, Tsai CH, Chang YY, Pan CT, Chang CC, Lee BC, Huang WC, Huang KH, Lu CC, Lai TS, Chan CK, Chueh JS, Wu VC, Hung CS, Chen ZW, Lin YH. Synergistic effect of albuminuria on atherosclerosis in patients with primary aldosteronism. Ther Adv Chronic Dis 2023; 14:20406223231210114. [PMID: 38362007 PMCID: PMC10867404 DOI: 10.1177/20406223231210114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/10/2023] [Indexed: 02/17/2024] Open
Abstract
Background Primary aldosteronism (PA) has been associated with atherosclerosis beyond the extent of essential hypertension, but the impact of albuminuria remains unknown. Objective To investigate the effect of concomitant albuminuria on arterial stiffness in PA. Design Prospective cohort study. Methods A prospective cohort study was conducted to evaluate the association of albuminuria (>30 mg/g in morning spot urine) with arterial stiffness, as measured non-invasively by pulse wave velocity (PWV) in patients with PA. Propensity score matching (PSM) with age, sex, diabetes, systolic and diastolic blood pressure, creatinine, potassium, number of antihypertensive medications, and hypertension history was used to balance baseline characteristics. The effects of albuminuria on PWV before and 1 year after treatment were analyzed. Results A total of 840 patients with PA were enrolled, of whom 243 had concomitant albuminuria. After PSM, there were no significant differences in baseline demographic parameters except alpha-blocker and spironolactone use. PWV was greater in the presence of albuminuria (p = 0.012) and positively correlated with urine albumin-creatinine ratio. Multivariable regression analysis identified albuminuria, age, body weight, systolic blood pressure, and calcium channel blocker use as independent predictors of PWV. As for treatment response, only PA patients with albuminuria showed significant improvements in PWV after PSM (p = 0.001). The magnitude of improvement in PWV increased with urine albumin-creatinine ratio and reached plateau when it exceeded 100 mg/g according to restricted cubic spline analysis. Conclusion Concomitant albuminuria in PA was associated with greater arterial stiffness and more substantial improvement after targeted treatment. Both the baseline and the improved extent of PWV increased in correlation with rising urine albumin-creatinine ratio levels, reaching a plateau when the urine albumin-creatinine ratio surpassed 100 mg/g.
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Affiliation(s)
- Ting-Wei Kao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medicine, National University Cancer Center, Taipei, Taiwan
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Yao Chang
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan City, Taiwan
| | - Chien-Ting Pan
- Department of Internal Medicine, National University Hospital and National University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National University Hospital and National University College of Medicine, Taipei, Taiwan
| | - Bo-Ching Lee
- Department of Medical Imaging, National University Hospital and National University College of Medicine, Taipei, Taiwan
| | - Wei-Chieh Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuo-How Huang
- Department of Urology, National University Hospital and National University College of Medicine, Taipei, Taiwan
| | - Ching-Chu Lu
- Department of Nuclear Medicine, National University Hospital, Taipei, Taiwan
| | - Tai-Shuan Lai
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chieh-Kai Chan
- Department of Internal Medicine, National University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | | | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Zheng-Wei Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, No. 579, Sec. 2, Yun-Lin Rd., Douliu City, Yun-Lin County 640203
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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2
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Rizzoni D, Agabiti-Rosei C, Boari GEM, Muiesan ML, De Ciuceis C. Microcirculation in Hypertension: A Therapeutic Target to Prevent Cardiovascular Disease? J Clin Med 2023; 12:4892. [PMID: 37568294 PMCID: PMC10419740 DOI: 10.3390/jcm12154892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Arterial hypertension is a common condition worldwide and an important risk factor for cardio- and cerebrovascular events, renal diseases, as well as microvascular eye diseases. Established hypertension leads to the chronic vasoconstriction of small arteries as well as to a decreased lumen diameter and the thickening of the arterial media or wall with a consequent increased media-to-lumen ratio (MLR) or wall-to-lumen ratio (WLR). This process, defined as vascular remodeling, was firstly demonstrated in small resistance arteries isolated from subcutaneous biopsies and measured by micromyography, and this is still considered the gold-standard method for the assessment of structural alterations in small resistance arteries; however, microvascular remodeling seems to represent a generalized phenomenon. An increased MLR may impair the organ flow reserve, playing a crucial role in the maintenance and, probably, also in the progressive worsening of hypertensive disease, as well as in the development of hypertension-mediated organ damage and related cardiovascular events, thus possessing a relevant prognostic relevance. New non-invasive techniques, such as scanning laser Doppler flowmetry or adaptive optics, are presently under development, focusing mainly on the evaluation of WLR in retinal arterioles; recently, also retinal microvascular WLR was demonstrated to have a prognostic impact in terms of cardio- and cerebrovascular events. A rarefaction of the capillary network has also been reported in hypertension, which may contribute to flow reduction in and impairment of oxygen delivery to different tissues. These microvascular alterations seem to represent an early step in hypertension-mediated organ damage since they might contribute to microvascular angina, stroke, and renal dysfunction. In addition, they can be markers useful in monitoring the beneficial effects of antihypertensive treatment. Additionally, conductance arteries may be affected by a remodeling process in hypertension, and an interrelationship is present in the structural changes in small and large conductance arteries. The review addresses the possible relations between structural microvascular alterations and hypertension-mediated organ damage, and their potential improvement with antihypertensive treatment.
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Affiliation(s)
- Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (C.A.-R.); (M.L.M.); (C.D.C.)
| | - Claudia Agabiti-Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (C.A.-R.); (M.L.M.); (C.D.C.)
- Second Division of Medicine, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Gianluca E. M. Boari
- Division of Medicine, Spedali Civili di Brescia, Montichiari, 25123 Brescia, Italy;
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (C.A.-R.); (M.L.M.); (C.D.C.)
- Second Division of Medicine, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Carolina De Ciuceis
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (C.A.-R.); (M.L.M.); (C.D.C.)
- Second Division of Medicine, Spedali Civili di Brescia, 25123 Brescia, Italy
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3
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Rizzoni D, Agabiti-Rosei C, De Ciuceis C. State of the Art Review: Vascular Remodeling in Hypertension. Am J Hypertens 2023; 36:1-13. [PMID: 35961002 DOI: 10.1093/ajh/hpac093] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/29/2022] [Accepted: 08/08/2022] [Indexed: 01/05/2023] Open
Abstract
Although the gold-standard method for the assessment of structural alteration in small resistance arteries is the evaluation of the MLR by micromyography in bioptic tissues, new, noninvasive techniques are presently under development, focusing mainly on the evaluation of WLR in retinal arterioles. These approaches represent a promising and interesting future perspective. Appropriate antihypertensive treatment is able to prevent the development of microvascular alterations or to induce their regression. Also, conductance arteries may be affected by a remodeling process in hypertension, and a cross-talk may exist between structural changes in the small and large arteries. In conclusion, the evaluation of microvascular structure is ready for clinical prime time, and it could, in the future, represent an evaluation to be performed in the majority of hypertensive patients, to better stratify cardiovascular risk and better evaluate the effects of antihypertensive therapy. However, for this purpose, we need a clear demonstration of the prognostic relevance of noninvasive measures of microvascular structure, in basal conditions and during treatment. Vascular remodeling may be frequently observed in hypertension, as well as in obesity and diabetes mellitus. An increased media to lumen ratio (MLR) or wall to lumen ratio (WLR) in microvessels is the hallmark of hypertension, and may impair organ flow reserve, being relevant in the maintenance and, probably, also in the progressive worsening of hypertensive disease, as well as in the development of hypertension-mediated organ damage/cardiovascular events. The molecular mechanisms underlying the development of vascular remodeling are only partly understood.
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Affiliation(s)
- Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Division of Medicine, Spedali Civili di Brescia, Montichiari (Brescia), Italy
| | - Claudia Agabiti-Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Second Division of Medicine, Spedali Civili di Brescia, Brescia, Italy
| | - Carolina De Ciuceis
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Second Division of Medicine, Spedali Civili di Brescia, Brescia, Italy
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4
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Kaushik S, Majtan B, Holaj R, Baručić D, Kološová B, Widimský J, Kybic J. The Effect of Primary Aldosteronism on Carotid Artery Texture in Ultrasound Images. Diagnostics (Basel) 2022; 12:diagnostics12123206. [PMID: 36553213 PMCID: PMC9777625 DOI: 10.3390/diagnostics12123206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Primary aldosteronism (PA) is the most frequent cause of secondary hypertension. Early diagnoses of PA are essential to avoid the long-term negative effects of elevated aldosterone concentration on the cardiovascular and renal system. In this work, we study the texture of the carotid artery vessel wall from longitudinal ultrasound images in order to automatically distinguish between PA and essential hypertension (EH). The texture is characterized using 140 Haralick and 10 wavelet features evaluated in a region of interest in the vessel wall, followed by the XGBoost classifier. Carotid ultrasound studies were carried out on 33 patients aged 42-72 years with PA, 52 patients with EH, and 33 normotensive controls. For the most clinically relevant task of distinguishing PA and EH classes, we achieved a classification accuracy of 73% as assessed by a leave-one-out procedure. This result is promising even compared to the 57% prediction accuracy using clinical characteristics alone or 63% accuracy using a combination of clinical characteristics and intima-media thickness (IMT) parameters. If the accuracy is improved and the method incorporated into standard clinical procedures, this could eventually lead to an improvement in the early diagnosis of PA and consequently improve the clinical outcome for these patients in future.
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Affiliation(s)
- Sumit Kaushik
- Faculty of Electrical Engineering, Czech Technical University in Prague, Karlovo Náměstí 293/13, 12 000 Prague, Czech Republic
| | - Bohumil Majtan
- Penta Hospitals CZ, Nemocnice Ostrov, U Nemocnice 1161, 363 01 Ostrov, Czech Republic
- 1st Faculty of Medicine, Charles University in Prague, Kateřinská 32, 128 21 Prague, Czech Republic
| | - Robert Holaj
- 1st Faculty of Medicine, Charles University in Prague, Kateřinská 32, 128 21 Prague, Czech Republic
- Centre for Hypertension, 3rd Department of Medicine, General University Hospital in Prague, U Nemocnice 504/1, 128 08 Prague, Czech Republic
- Correspondence: ; Tel.: +420-224-963-509
| | - Denis Baručić
- Faculty of Electrical Engineering, Czech Technical University in Prague, Karlovo Náměstí 293/13, 12 000 Prague, Czech Republic
| | - Barbora Kološová
- 1st Faculty of Medicine, Charles University in Prague, Kateřinská 32, 128 21 Prague, Czech Republic
- Centre for Hypertension, 3rd Department of Medicine, General University Hospital in Prague, U Nemocnice 504/1, 128 08 Prague, Czech Republic
| | - Jiří Widimský
- 1st Faculty of Medicine, Charles University in Prague, Kateřinská 32, 128 21 Prague, Czech Republic
- Centre for Hypertension, 3rd Department of Medicine, General University Hospital in Prague, U Nemocnice 504/1, 128 08 Prague, Czech Republic
| | - Jan Kybic
- Faculty of Electrical Engineering, Czech Technical University in Prague, Karlovo Náměstí 293/13, 12 000 Prague, Czech Republic
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5
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Gkaliagkousi E, Lazaridis A, Anyfanti P, Stavropoulos K, Imprialos K, Triantafyllou A, Mastrogiannis K, Douma S, Doumas M. Assessment of skin microcirculation in primary aldosteronism: impaired microvascular responses compared to essential hypertensives and normotensives. J Hum Hypertens 2022; 36:1066-1071. [PMID: 34802038 DOI: 10.1038/s41371-021-00639-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022]
Abstract
Primary aldosteronism (PA) is associated with considerably higher cardiovascular risk and increased prevalence of organ damage compared to essential hypertension (EH). Laser speckle contrast imaging (LSCI) has emerged as a novel non-invasive tool to assess of skin microcirculation. Our aim was to evaluate skin microvascular function (SMF) using LSCI coupled with post-occlusive reactive hyperemia (PORH) in a group of PA patients (PAs) compared to patients with EH (EHs) and normotensive controls (NTs). We enrolled PAs, age- and gender-matched with EHs and NTs. All participants underwent SMF assessment by LSCI with PORH. We enrolled 109 participants including 29 PAs, 47 EHs, and 33 NTs. SMF was significantly impaired in PAs, including peak time (p < 0.001) and base to peak flux (p < 0.001) compared to NTs and EHs. Among PAs, plasma aldosterone showed a positive correlation with occlusion flux (p = 0.005). Our study shows for the first time that PAs present impaired SMF as assessed with LSCI coupled with PORH, not only compared to NTs but also compared to EHs with similar blood pressure profile. Further studies are needed to investigate the clinical impact of such alterations in terms of pathophysiology and cardiovascular risk prediction.
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Affiliation(s)
- Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Antonios Lazaridis
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiota Anyfanti
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Stavropoulos
- 2nd Propedeutic Department of Internal Medicine, Hippokrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Imprialos
- 2nd Propedeutic Department of Internal Medicine, Hippokrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Mastrogiannis
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Douma
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michalis Doumas
- 2nd Propedeutic Department of Internal Medicine, Hippokrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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6
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Validation of Existing Clinical Prediction Tools for Primary Aldosteronism Subtyping. Diagnostics (Basel) 2022; 12:diagnostics12112806. [PMID: 36428866 PMCID: PMC9689974 DOI: 10.3390/diagnostics12112806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022] Open
Abstract
The new clinical prediction score (SCORE) has been recently proposed for primary aldosteronism (PA) subtyping prior to adrenal vein sampling (AVS). This study aimed to compare that SCORE with previously published scores and their validation using a cohort of patients at our center who had had positive SIT confirming PA and had been diagnosed with either bilateral PA according to AVS or unilateral PA if biochemically cured after an adrenalectomy. Final diagnoses were used to evaluate the diagnostic performance of the proposed clinical prediction tools. Only Kamemura's model (with a maximum score of 4 points) and Kobayashi's score (with a maximum score of 12 points) reached 100% reliability for prediction of bilateral PA; however, with sensitivity of only 3%. On the other hand, the values of SCORE = 3 (with sensitivity of 48%), the SPACE score ≥18 (with sensitivity of 35%), the Kobayashi's score ≤2 (with sensitivity of 28%), and the Kocjan's score = 3 (with sensitivity of 28%) were able to predict unilateral PA with 100% probability. Furthermore, Umakoshi's and Young's models both reached 100% reliability for a unilateral PA with score = 4 and both predictive factors together respectively; however, the sensitivity was lower compared with previous models; 4% and 14%, respectively. None of the clinical prediction tools applied to our cohort predicted unilateral and bilateral subtypes together with the expected high diagnostic performance, and therefore can only be used for precisely defined cases.
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7
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Lin X, Ullah MHE, Wu X, Xu F, Shan SK, Lei LM, Yuan LQ, Liu J. Cerebro-Cardiovascular Risk, Target Organ Damage, and Treatment Outcomes in Primary Aldosteronism. Front Cardiovasc Med 2022; 8:798364. [PMID: 35187110 PMCID: PMC8847442 DOI: 10.3389/fcvm.2021.798364] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/20/2021] [Indexed: 02/03/2023] Open
Abstract
Primary aldosteronism (PA) is the most common type of endocrine hypertension, and numerous experimental and clinical evidence have verified that prolonged exposure to excess aldosterone is responsible for an increased risk of cerebro-cardiovascular events and target organ damage (TOD) in patients with PA. Therefore, focusing on restoring the toxic effects of excess aldosterone on the target organs is very important to reduce cerebro-cardiovascular events. Current evidence convincingly demonstrates that both surgical and medical treatment strategies would benefit cerebro-cardiovascular outcomes and mortality in the long term. Understanding cerebro-cardiovascular risk in PA would help clinical doctors to achieve both early diagnosis and treatment. Therefore, in this review, we will summarize the cerebro-cardiovascular risk in PA, focusing on the TOD of aldosterone, including brain, heart, vascular system, renal, adipose tissues, diabetes, and obstructive sleep apnea (OSA). Furthermore, the various treatment outcomes of adrenalectomy and medical treatment for patients with PA will also be discussed. We hope this knowledge will help improve cerebro-cardiovascular prognosis and reduce the incidence and mortality of cerebro-cardiovascular events in patients with PA.
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Affiliation(s)
- Xiao Lin
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Muhammad Hasnain Ehsan Ullah
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiong Wu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Feng Xu
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Su-Kang Shan
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Li-Min Lei
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ling-Qing Yuan
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
- Ling-Qing Yuan
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, China
- Department of Radiology Quality Control Center in Hunan Province, Changsha, China
- *Correspondence: Jun Liu
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8
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Chen ZW, Pan CT, Tsai CH, Chang YY, Chang CC, Lee BC, Chiu YW, Huang WC, Lin YL, Wu VC, Hung CS, Liao CW, Lin YH. Heart-Ankle Pulse Wave Velocity Is Superior to Brachial-Ankle Pulse Wave Velocity in Detecting Aldosterone-Induced Arterial Stiffness. Biomedicines 2021; 9:biomedicines9101285. [PMID: 34680402 PMCID: PMC8533381 DOI: 10.3390/biomedicines9101285] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 12/01/2022] Open
Abstract
Primary aldosteronism (PA) is associated with higher arterial stiffness compared to essential hypertension (EH). However, few studies have compared different pulse wave velocity (PWV) parameters to detect aldosterone-induced arterial stiffness. In this study, we aimed to compare the sensitivity in detecting aldosterone-induced arterial stiffness between brachial-ankle PWV (baPWV) and heart-ankle PWV (haPWV). We prospectively enrolled 1006 PA patients and 983 EH patients. Detailed medical history, basic biochemistry data and two PWV measurements (baPWV and haPWV) were collected in both groups. We performed analysis on the original cohort and two propensity score matching (PSM) models (model 1 adjusted for age and sex; model 2 adjusted for age, sex, systolic and diastolic blood pressure). The DeLong test was used to compare areas under receiver operating characteristic curves (AUCs) between baPWV and haPWV to predict PA. In all models, the PA patients had significantly higher baPWV compared to the EH patients. The AUC of haPWV was greater than that of baPWV. In conclusion, haPWV seems to be a better PWV parameter than baPWV in detecting aldosterone-induced arterial stiffness.
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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; (Z.-W.C.); (C.-T.P.); (C.-H.T.); (V.-C.W.); (C.-S.H.)
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin 640, Taiwan
| | - Chien-Ting Pan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (Z.-W.C.); (C.-T.P.); (C.-H.T.); (V.-C.W.); (C.-S.H.)
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin 640, Taiwan
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (Z.-W.C.); (C.-T.P.); (C.-H.T.); (V.-C.W.); (C.-S.H.)
- 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; (Y.-Y.C.); (Y.-W.C.)
| | - Chin-Chen Chang
- Department of Medical Imaging, College of Medicine, National Taiwan University Hospital and National Taiwan University, Taipei 100, Taiwan; (C.-C.C.); (B.-C.L.)
| | - Bo-Ching Lee
- Department of Medical Imaging, College of Medicine, National Taiwan University Hospital and National Taiwan University, Taipei 100, Taiwan; (C.-C.C.); (B.-C.L.)
| | - Yu-Wei Chiu
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan; (Y.-Y.C.); (Y.-W.C.)
- 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;
| | - Yu-Li Lin
- Department of Business Administration and Graduate School of Service Management, Chihlee University of Technology, New Taipei City 220, Taiwan;
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (Z.-W.C.); (C.-T.P.); (C.-H.T.); (V.-C.W.); (C.-S.H.)
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (Z.-W.C.); (C.-T.P.); (C.-H.T.); (V.-C.W.); (C.-S.H.)
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (Z.-W.C.); (C.-T.P.); (C.-H.T.); (V.-C.W.); (C.-S.H.)
- Department of Medicine, National Taiwan University Cancer Center, Taipei 106, Taiwan
- Correspondence: (C.-W.L.); (Y.-H.L.); Tel.: +886-2-23123456 (ext. 62152) (Y.-H.L.)
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (Z.-W.C.); (C.-T.P.); (C.-H.T.); (V.-C.W.); (C.-S.H.)
- Correspondence: (C.-W.L.); (Y.-H.L.); Tel.: +886-2-23123456 (ext. 62152) (Y.-H.L.)
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9
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Burrello J, Tetti M, Forestiero V, Biemmi V, Bolis S, Pomatto MAC, Amongero M, Di Silvestre D, Mauri P, Vassalli G, Camussi G, Williams TA, Mulatero P, Barile L, Monticone S. Characterization of Circulating Extracellular Vesicle Surface Antigens in Patients With Primary Aldosteronism. Hypertension 2021; 78:726-737. [PMID: 34304584 DOI: 10.1161/hypertensionaha.121.17136] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Jacopo Burrello
- From the Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (J.B., M.T., V.F., T.A.W., P. Mulatero, S.M.).,Laboratory for Cardiovascular Theranostics and Laboratory of Cellular and Molecular Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland (J.B., V.B., S.B., G.V., L.B.)
| | - Martina Tetti
- From the Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (J.B., M.T., V.F., T.A.W., P. Mulatero, S.M.)
| | - Vittorio Forestiero
- From the Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (J.B., M.T., V.F., T.A.W., P. Mulatero, S.M.)
| | - Vanessa Biemmi
- Laboratory for Cardiovascular Theranostics and Laboratory of Cellular and Molecular Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland (J.B., V.B., S.B., G.V., L.B.).,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (V.B., L.B.)
| | - Sara Bolis
- Laboratory for Cardiovascular Theranostics and Laboratory of Cellular and Molecular Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland (J.B., V.B., S.B., G.V., L.B.)
| | | | - Martina Amongero
- Department of Mathematical Sciences G. L. Lagrange, Polytechnic University of Torino, Italy (M.A.)
| | - Dario Di Silvestre
- Proteomic and Metabolomic Laboratory, Institute for Biomedical Technologies-National Research Council (ITB-CNR), Segrate (Milan), Italy (D.D.S., P. Mauri)
| | - Pierluigi Mauri
- Proteomic and Metabolomic Laboratory, Institute for Biomedical Technologies-National Research Council (ITB-CNR), Segrate (Milan), Italy (D.D.S., P. Mauri)
| | - Giuseppe Vassalli
- Laboratory for Cardiovascular Theranostics and Laboratory of Cellular and Molecular Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland (J.B., V.B., S.B., G.V., L.B.)
| | - Giovanni Camussi
- Molecular Biotechnology Center, Department of Medical Sciences, University of Torino, Italy (M.A.C.P., G.C.)
| | - Tracy Ann Williams
- From the Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (J.B., M.T., V.F., T.A.W., P. Mulatero, S.M.).,Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany (T.A.W)
| | - Paolo Mulatero
- From the Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (J.B., M.T., V.F., T.A.W., P. Mulatero, S.M.)
| | - Lucio Barile
- Laboratory for Cardiovascular Theranostics and Laboratory of Cellular and Molecular Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland (J.B., V.B., S.B., G.V., L.B.).,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (V.B., L.B.)
| | - Silvia Monticone
- From the Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (J.B., M.T., V.F., T.A.W., P. Mulatero, S.M.)
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10
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Jurek A, Krzesiński P, Gielerak G, Witek P, Zieliński G, Kazimierczak A, Wierzbowski R, Banak M, Uziębło-Życzkowska B. Cushing's Disease: Assessment of Early Cardiovascular Hemodynamic Dysfunction With Impedance Cardiography. Front Endocrinol (Lausanne) 2021; 12:751743. [PMID: 34659130 PMCID: PMC8517395 DOI: 10.3389/fendo.2021.751743] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cushing's disease is a rare condition associated with a high cardiovascular risk and hypercortisolemia-related hemodynamic dysfunction, the extent of which can be assessed with a noninvasive method, called impedance cardiography. The standard methods for hemodynamic assessment, such as echocardiography or ambulatory blood pressure monitoring may be insufficient to fully evaluate patients with Cushing's disease; therefore, impedance cardiography is being currently considered a new modality for assessing early hemodynamic dysfunction in this patient population. The use of impedance cardiography for diagnosis and treatment of Cushing's disease may serve as personalized noninvasive hemodynamic status assessment and provide a better insight into the pathophysiology of Cushing's disease. The purpose of this study was to assess the hemodynamic profile of Cushing's disease patients and compare it with that in the control group. MATERIAL AND METHODS This observational prospective clinical study aimed to compare 54 patients with Cushing's disease (mean age 41 years; with 64.8% of this population affected with arterial hypertension) and a matched 54-person control group (mean age 45 years; with 74.1% of this population affected with arterial hypertension). The hemodynamic parameters assessed with impedance cardiography included the stroke index (SI), cardiac index (CI), systemic vascular resistance index (SVRI), velocity index (VI), (ACI), Heather index (HI), and thoracic fluid content (TFC). RESULTS The Cushing's disease group was characterized by a higher diastolic blood pressure and a younger age than the control group (82.9 vs. 79.1 mmHg, p=0.045; and 41.1 vs. 44.9 years, p=0.035, respectively). Impedance cardiography parameters in the Cushing's disease group showed: lower values of SI (42.1 vs. 52.8 ml/m2; p ≤ 0.0001), CI (2.99 vs. 3.64 l/min/m2; p ≤ 0,0001), VI (42.9 vs. 52.1 1/1000/s; p=0.001), ACI (68.7 vs. 80.5 1/100/s2; p=0,037), HI (13.1 vs. 15.2 Ohm/s2; p=0.033), and TFC (25.5 vs. 27.7 1/kOhm; p=0.006) and a higher SVRI (2,515 vs. 1,893 dyn*s*cm-5*m2; p ≤ 0.0001) than those in the control group. CONCLUSIONS Cushing's disease is associated with significantly greater vasoconstriction and left ventricular systolic dysfunction. An individual assessment with impedance cardiography may be useful in Cushing's disease patients in order to identify subclinical cardiovascular complications of chronic hypercortisolemia as potential therapeutic targets.
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Affiliation(s)
- Agnieszka Jurek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
- *Correspondence: Agnieszka Jurek,
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Grzegorz Gielerak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Przemysław Witek
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Zieliński
- Department of Neurosurgery, Military Institute of Medicine, Warsaw, Poland
| | - Anna Kazimierczak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Robert Wierzbowski
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Małgorzata Banak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
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11
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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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12
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Chan CK, Yang WS, Lin YH, Huang KH, Lu CC, Hu YH, Wu VC, Chueh JS, Chu TS, Chen YM. Arterial Stiffness Is Associated with Clinical Outcome and Cardiorenal Injury in Lateralized Primary Aldosteronism. J Clin Endocrinol Metab 2020; 105:5896591. [PMID: 32835357 DOI: 10.1210/clinem/dgaa566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/17/2020] [Indexed: 12/19/2022]
Abstract
CONTEXT The association between arterial stiffness and clinical outcome in lateralized primary aldosteronism (PA) patients after adrenalectomy has not been clearly identified. OBJECTIVE We hypothesized that arterial stiffness estimated by brachial-ankle pulse wave velocity (baPWV) before adrenalectomy was associated with the clinical outcomes and cardiorenal injury in lateralized PA patients after adrenalectomy. DESIGN AND PATIENTS We designed a retrospective observational cohort study. We collected lateralized PA patients who had undergone adrenalectomy between 2013 and 2016 from the Taiwan Primary Aldosteronism Investigation database. The primary outcome was achieving complete clinical success at 1 year after adrenalectomy. The secondary outcome was estimated glomerular filtration rate declining over 20% and improved left ventricular mass index. RESULTS We enrolled 221 patients with lateralized PA (50.7% men; mean age, 51.9 years), of whom 101 patients (45.7%) achieved complete clinical success at the 1-year follow-up assessment after adrenalectomy. Lower baPWV before adrenalectomy (odds ratio = 0.998; 95% confidence interval, 0.996-0.999; P = 0.003) correlated with higher likelihood of complete clinical success by multivariate logistic regression analysis. Multifactorial adjusted generalized additive model demonstrated that preoperative baPWV<1600 cm/sec was significantly associated with complete cure of hypertension. In addition, higher preoperative baPWV was associated with renal function decline and less left ventricular mass regression after adrenalectomy in lateralized PA patients during the follow-up period. CONCLUSIONS Our study demonstrated that the preoperative severe arterial stiffness was associated with absent complete clinical success in lateralized PA patients after adrenalectomy, and this effect may contribute to cardiorenal injury, which at least partially explains kidney function deterioration and lessened regression of heart mass.
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Affiliation(s)
- Chieh-Kai Chan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu branch, Hsin Chu County, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Shiung Yang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuo-How Huang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Chu Lu
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Hui Hu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jeff S Chueh
- Glickman Urological and Kidney Institute, and Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Tzong-Shinn Chu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Ming Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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13
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Comparisons of skin microvascular changes in patients with primary aldosteronism and essential hypertension. Hypertens Res 2020; 43:1222-1230. [PMID: 32488215 DOI: 10.1038/s41440-020-0475-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 11/08/2022]
Abstract
The aim of our cross-sectional study was to evaluate skin microvascular alterations in patients with hypertension secondary to primary aldosteronism (PA) and in subjects with essential hypertension (EH). Skin microcirculation was detected by nailfold videocapillaroscopy (NVC) and laser Doppler perfusion imaging (LDPI), both noninvasive techniques for the evaluation of digital capillaroscopic damage and hand skin blood perfusion. From September 2018 to April 2019, we consecutively enrolled 80 patients, of whom 42 had PA and 38 had EH. A morphological and structural study of cutaneous microcirculation was carried out through NVC, while functional evaluation of the peripheral microcirculation was carried out with LDPI. Using LDPI indices, dermal perfusion gradients were calculated in various regions of interest at the level of the back of the hand (ROI1 and ROI2). No differences between the two groups in NVC parameters were found. In contrast, LDPI showed worse skin perfusion parameters in patients with PA compared with patients with EH (ROI1: 143.9 ± 29.9 pU vs 163.3 ± 35.2 pU, p = 0.01; perfusion gradient ROI1-ROI2: 62.4 ± 28.8 pU vs 79.3 ± 33.5 pU, p = 0.019). Furthermore, the ROI1-ROI2 (proximal-distal) perfusion gradient was negatively correlated with aldosterone plasma levels (r -0.269; p = 0.017). Multivariate analysis showed that aldosterone was significantly associated with the ROI1-ROI2 perfusion gradient (b -0.220; p = 0.044). Patients with PA showed altered skin perfusion and greater microvascular dysfunction compared with the EH group. Our results are consistent with the hypothesis that aldosterone may have a pathophysiological role in microvascular remodeling in patients with PA, with predominant functional dysfunction.
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14
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Barbot M, Zilio M, Scaroni C. Cushing's syndrome: Overview of clinical presentation, diagnostic tools and complications. Best Pract Res Clin Endocrinol Metab 2020; 34:101380. [PMID: 32165101 DOI: 10.1016/j.beem.2020.101380] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cushing's syndrome (CS) is a severe condition that results from chronic exposure to elevated circulating cortisol levels; it is a rare but potentially life-threating condition, especially when not timely diagnosed and treated. Even though the diagnosis can be straightforward in florid cases due to their typical phenotype, milder forms can be missed. Despite the availability of different screening tests, the diagnosis remains challenging as none of the available tools proved to be fully accurate. Due to the ubiquitous effect of cortisol, it is easy understandable that its excess leads to a variety of systemic complications including hypertension, metabolic syndrome, bone damages and neurocognitive impairment. This article discusses clinical presentation of CS with an eye on the most frequent cortisol-related comorbidities and discuss the main pitfalls of first- and second-line tests in endogenous hypercortisolism diagnostic workup.
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Affiliation(s)
- Mattia Barbot
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Italy.
| | - Marialuisa Zilio
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Italy
| | - Carla Scaroni
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Italy
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15
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Schiffrin EL. How Structure, Mechanics, and Function of the Vasculature Contribute to Blood Pressure Elevation in Hypertension. Can J Cardiol 2020; 36:648-658. [PMID: 32389338 DOI: 10.1016/j.cjca.2020.02.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 01/11/2023] Open
Abstract
Large conduit arteries and the microcirculation participate in the mechanisms of elevation of blood pressure (BP). Large vessels play roles predominantly in older subjects, with stiffening progressing after middle age leading to increases in systolic BP found in most humans with aging. Systolic BP elevation and increased pulsatility penetrate deeper into the distal vasculature, leading to microcirculatory injury, remodelling, and associated endothelial dysfunction. The result is target organ damage in the heart, brain, and kidney. In younger individuals genetically predisposed to high BP, increased salt intake or other exogenous or endogenous risk factors for hypertension, including overweight and excess alcohol intake, lead to enhanced sympathetic activity and vasoconstriction. Enhanced vasoconstrictor responses and myogenic tone become persistent when embedded in an increased extracellular matrix, resulting in remodelling of resistance arteries with a narrowed lumen and increased media-lumen ratio. Stimulation of the renin-angiotensin-aldosterone and endothelin systems and inflammatory and immune activation, to which gut microbiome dysbiosis may contribute as a result of salt intake, also participate in the injury and remodelling of the microcirculation and endothelial dysfunction. Inflammation of perivascular fat and loss of anticontractile factors play roles as well in microvessel remodelling. Exaggerated myogenic tone leads to closure of terminal arterioles, collapse of capillaries and venules, functional rarefaction, and eventually to anatomic rarefaction, compromising tissue perfusion. The remodelling of the microcirculation raises resistance to flow, and accordingly raises BP in a feedback process that over years results in stiffening of conduit arteries and systo-diastolic or predominantly systolic hypertension and, more rarely, predominantly diastolic hypertension. Thus, at different stages of life and the evolution of hypertension, large vessels and the microcirculation interact to contribute to BP elevation.
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Affiliation(s)
- Ernesto L Schiffrin
- Lady Davis Institute for Medical Research and Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montréal, Québec, Canada.
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16
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Li D, El Kawkgi OM, Henriquez AF, Bancos I. Cardiovascular risk and mortality in patients with active and treated hypercortisolism. Gland Surg 2020; 9:43-58. [PMID: 32206598 DOI: 10.21037/gs.2019.11.03] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Patients with hypercortisolism demonstrate high cardiovascular morbidity and mortality, especially if diagnosis is delayed. Hypercortisolism-induced cardiovascular and metabolic comorbidities include hypertension, impaired glucose metabolism, dyslipidemia, and obesity. High prevalence of cardiovascular risk factors leads to increased rate of cardiovascular events and mortality. This risk is reduced, albeit not reversed even after successful treatment of hypercortisolism. In this review we will describe prevalence and mechanisms of cardiovascular comorbidities in patients with hypercortisolism. In addition, we will summarize the effect of therapy on cardiovascular risk factors, events, as well as mortality.
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Affiliation(s)
- Dingfeng Li
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Omar M El Kawkgi
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Andres F Henriquez
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Irina Bancos
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
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17
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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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18
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Demirkiran A, Everaars H, Elitok A, van de Ven PM, Smulders YM, Dreijerink KM, Tanakol R, Ozcan M. Hypertension with primary aldosteronism is associated with increased carotid intima-media thickness and endothelial dysfunction. J Clin Hypertens (Greenwich) 2019; 21:932-941. [PMID: 31187936 PMCID: PMC6771730 DOI: 10.1111/jch.13585] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/03/2019] [Accepted: 04/21/2019] [Indexed: 01/22/2023]
Abstract
Patients with primary aldosteronism induced hypertension are more likely to experience cardiovascular events compared to patients with essential hypertension. Primary aldosteronism may therefore have distinct adverse effects on cardiovascular structure and function, independent of hypertension. However, current data on such effects of primary aldosteronism are conflicting. The aim of the present study was to investigate the influence of primary aldosteronism on vascular structure and endothelial function, using intima‐media thickness as a vascular remodeling index and flow‐mediated dilation as a functional parameter. In total, 70 participants were recruited from patients with resistant hypertension. Twenty‐nine patients diagnosed with primary aldosteronism and 41 patients with essential hypertension were prospectively enrolled. Primary aldosteronism was due to aldosterone‐producing adenoma in 10 cases and due to idiopathic adrenal hyperplasia in 19 cases. All patients underwent ultrasound of the common carotid intima‐media thickness and flow‐mediated dilation of the brachial artery. Primary aldosteronism patients had significantly lower flow‐mediated dilation (3.3 [2.4‐7.4] % vs 14.7 [10.3‐19.9] %, P < 0.01) and significantly higher carotid intima‐media thickness (0.9 [0.7‐1.0] mm vs 0.8 [0.6‐0.9] mm, P = 0.02) compared to patients with essential hypertension. These differences remained significant after adjusting for age, sex, diabetes mellitus, 24‐hours systolic blood pressure, and smoking (P < 0.01). No differences in either outcome were observed between the adenoma and adrenal hyperplasia groups (both P > 0.05). Hypertensive patients with hyperaldosteronism appear to exhibit deteriorative effects on both vascular structure and function, independent of hypertension.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Henk Everaars
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ali Elitok
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Yvo M Smulders
- Division of Vascular Medicine, Department of Internal Medicine, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Koen M Dreijerink
- Division of Endocrinology, Department of Internal Medicine, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Refik Tanakol
- Division of Endocrinology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Ozcan
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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19
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Stavropoulos K, Papadopoulos C, Koutsampasopoulos K, Lales G, Mitas C, Doumas M. Mineralocorticoid Receptor Antagonists in Primary Aldosteronism. Curr Pharm Des 2019; 24:5508-5516. [DOI: 10.2174/1381612825666190311130138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/05/2019] [Indexed: 01/21/2023]
Abstract
Background:Primary aldosteronism is the most common causes of secondary hypertension. Patients suffering from this clinical syndrome have an increased cardiovascular risk and target organ damage. Mineralocorticoid receptor antagonists are the optimal pharmaceutical option for the management of such patients.Objectives:The study aimed to assess the effects of mineralocorticoid receptor antagonist in the treatment of patients with primary aldosteronism.Method:We conducted an in-depth review of the literature and comprehensive identification of the clinical studies investigating the efficacy of mineralocorticoid receptor antagonists in individuals with primary aldosteronism.Results:Mineralocorticoid receptor antagonists result in significant improvement in blood pressure and serum potassium level among patients with primary aldosteronism. Moreover, mineralocorticoid receptor antagonists reverse left ventricular hypertrophy, albuminuria, and carotid intima-media thickness. However, a high risk for atrial fibrillation remains among subject with primary aldosteronism in such agents.Conclusion:Mineralocorticoid receptor antagonists are recommended as the first-line treatment in patients with bilateral primary aldosteronism. In patients with unilateral aldosterone-producing adenoma, adrenalectomy should be preferred. However, existing data presents significant limitations and is rather inconclusive. Future randomized control trials are required in order to illustrate the field.
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Affiliation(s)
- Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos Papadopoulos
- Third Department of Cardiology, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Koutsampasopoulos
- Second Propedeutic Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Lales
- Second Propedeutic Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Mitas
- Second Propedeutic Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Favero G, Paini A, De Ciuceis C, Rodella LF, Moretti E, Porteri E, Rossini C, Ministrini S, Solaini L, Stefano C, Coschignano MA, Brami V, Petelca A, Nardin M, Valli I, Tiberio GAM, Bonomini F, Agabiti Rosei C, Portolani N, Rizzoni D, Rezzani R. Changes in extracellular matrix in subcutaneous small resistance arteries of patients with essential hypertension. Blood Press 2018. [PMID: 29523048 DOI: 10.1080/08037051.2018.1448256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND In the development of hypertensive microvascular remodeling, a relevant role may be played by changes in extracellular matrix proteins. Aim of this study was the to evaluate some extracellular matrix components within the tunica media of subcutaneous small arteries in 9 normotensive subjects and 12 essential hypertensive patients, submitted to a biopsy of subcutaneous fat from the gluteal or the anterior abdominal region. PATIENTS AND METHODS Subcutaneous small resistance arteries were dissected and mounted on an isometric myograph, and the tunica media to internal lumen ratio was measured. In addition, fibronectin, laminin, transforming growth factor-beta-1 (TGF-β1) and emilin-1 contents within the tunica media were evaluated by immunofluorescence and relative immunomorphometrical analysis (immunopositivity % of area). The total collagen content and collagen subtypes within the tunica media were evaluated using both Sirius red staining (under polarized light) and immunofluorescence assay. RESULTS Normotensive controls had less total and type III collagen in respect with hypertensive patients. Fibronectin and TGF-β1 tunica media content was significantly greater in essential hypertensive patients, compared with normotensive controls, while laminin and emilin-1 tunica media content was lesser in essential hypertensive patients, compared with normotensive controls. A significant correlation was observed between fibronectin tunica media content and media to lumen ratio. CONCLUSIONS Our results indicate that, in small resistance arteries of patients with essential hypertension, a relevant fibrosis may be detected; fibronectin and TGF-β1 tunica media content is increased, while laminin and emilin-1 content is decreased; these changes might be involved in the development of small resistance artery remodeling in humans.
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Affiliation(s)
- Gaia Favero
- a Anatomy and Physiopathology Division, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | - Anna Paini
- b Clinica Medica, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | - Carolina De Ciuceis
- b Clinica Medica, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | - Luigi F Rodella
- a Anatomy and Physiopathology Division, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy.,c Interdipartimental University Center of Research "Adaption and Regeneration of Tissues and Organs- (ARTO)", University of Brescia , Brescia , Italy
| | - Enrico Moretti
- a Anatomy and Physiopathology Division, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | - Enzo Porteri
- b Clinica Medica, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | - Claudia Rossini
- b Clinica Medica, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | - Silvia Ministrini
- d Clinica Chirurgica, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | - Leonardo Solaini
- d Clinica Chirurgica, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | - Caletti Stefano
- b Clinica Medica, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | | | - Valeria Brami
- b Clinica Medica, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | - Alina Petelca
- b Clinica Medica, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | - Matteo Nardin
- b Clinica Medica, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | - Ilenia Valli
- b Clinica Medica, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | - Guido A M Tiberio
- b Clinica Medica, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | - Francesca Bonomini
- a Anatomy and Physiopathology Division, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy.,c Interdipartimental University Center of Research "Adaption and Regeneration of Tissues and Organs- (ARTO)", University of Brescia , Brescia , Italy
| | - Claudia Agabiti Rosei
- b Clinica Medica, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | - Nazario Portolani
- d Clinica Chirurgica, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | - Damiano Rizzoni
- b Clinica Medica, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy.,e Division of Medicine , Istituto Clinico Città di Brescia , Brescia , Italy
| | - Rita Rezzani
- a Anatomy and Physiopathology Division, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy.,c Interdipartimental University Center of Research "Adaption and Regeneration of Tissues and Organs- (ARTO)", University of Brescia , Brescia , Italy
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Huang KH, Yu CC, Hu YH, Chang CC, Chan CK, Liao SC, Tsai YC, Jeff Chueh SC, Wu VC, Lin YH. Targeted treatment of primary aldosteronism - The consensus of Taiwan Society of Aldosteronism. J Formos Med Assoc 2018; 118:72-82. [PMID: 29506889 DOI: 10.1016/j.jfma.2018.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/25/2017] [Accepted: 01/05/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND/PURPOSE Even with the increasing recognition of primary aldosteronism (PA) as a cause of refractory hypertension and an issue of public health, the consensus of its optimal surgical or medical treatment in Taiwan has not been reached. Our objective was to develop a clinical practice guideline that is feasible for real-world management of PA patients in Taiwan. METHODS The Taiwan Society of Aldosteronism (TSA) Task Force recognized the above-mentioned issues and reached this Taiwan PA consensus at its inaugural meeting, in order to provide updated information of internationally acceptable standards, and also to incorporate our local disease characteristics and constraints into PA management. RESULTS In patients with lateralized PA, including aldosterone producing adenoma (APA), laparoscopic adrenalectomy is the 'gold standard' of treatment. Mini-laparoscopic and laparoendoscopic single-site approaches are feasible only in highly experienced surgeons. Patients with bilateral adrenal hyperplasia or those not suitable for surgery should be treated by mineralocorticoid receptor antagonists. The outcome data of PA patient management from the literature, especially from PA patients in Taiwan, are reviewed. Mental health screening is helpful in early detection and management of psychopathology among PA patients. CONCLUSION We hope this consensus will provide a guideline to help medical professionals to manage PA patients in Taiwan to achieve a better quality of care.
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Affiliation(s)
- Kuo-How Huang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Chin Yu
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan
| | - Ya-Hui Hu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, Taiwan
| | - Chin-Chen Chang
- Medical Imagine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh-Kai Chan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin Chu Branch, Hsinchu County, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Chou Tsai
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan; Department of Urology, Tzu Chi University, Hualien, Taiwan.
| | - Shih-Chieh Jeff Chueh
- Glickman Urological and Kidney Institute, and Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Vin-Cent Wu
- Division of Nephrology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hung Lin
- Division of Cardiology, National Taiwan University Hospital, Taipei, Taiwan
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Prevalence of primary aldosteronism in primary care: a cross-sectional study. Br J Gen Pract 2018; 68:e114-e122. [PMID: 29335324 DOI: 10.3399/bjgp18x694589] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/11/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Primary aldosteronism (PA) is the most frequent cause of secondary hypertension. Reported prevalences of PA vary considerably because of a large heterogeneity in study methodology. AIM To examine the proportion of patients with PA among patients with newly diagnosed, never treated hypertension. DESIGN AND SETTING A cross-sectional study set in primary care. METHOD GPs measured aldosterone and renin in adult patients with newly diagnosed, never treated hypertension. Patients with elevated aldosterone-to-renin ratio and increased plasma aldosterone concentration underwent a saline infusion test to confirm or exclude PA. The source population was meticulously assessed to detect possible selection bias. RESULTS Of 3748 patients with newly diagnosed hypertension, 343 patients were screened for PA. In nine out of 74 patients with an elevated aldosterone-to-renin ratio and increased plasma aldosterone concentration the diagnosis of PA was confirmed by a saline infusion test, resulting in a prevalence of 2.6% (95% confidence interval = 1.4 to 4.9). All patients with PA were normokalaemic and 8 out of 9 patients had sustained blood pressure >150/100 mmHg. Screened patients were younger (P<0.001) or showed higher blood pressure (P<0.001) than non-screened patients. CONCLUSION In this study a prevalence of PA of 2.6% in a primary care setting was established, which is lower than estimates reported from other primary care studies so far. This study supports the screening strategy as recommended by the Endocrine Society Clinical Practice Guideline. The low proportion of screened patients (9.2%), of the large cohort of eligible patients, reflects the difficulty of conducting prevalence studies in primary care clinical practice.
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23
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Yan Y, Wang C, Lu Y, Gong H, Wu Z, Ma X, Li H, Wang B, Zhang X. Mineralocorticoid receptor antagonism protects the aorta from vascular smooth muscle cell proliferation and collagen deposition in a rat model of adrenal aldosterone-producing adenoma. J Physiol Biochem 2017; 74:17-24. [PMID: 29164516 DOI: 10.1007/s13105-017-0600-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
The number of patients with adrenal aldosterone-producing adenomas (APAs) has gradually increased. However, even after adenoma resection, some patients still suffer from high systolic blood pressure (SBP), which is possibly due to great arterial remodeling. Moreover, mineralocorticoid receptors (MRs) were found to be expressed in vascular smooth muscle cells (VSMCs). This study aims to determine whether MR antagonism protects the aorta from aldosterone-induced aortic remolding. Male rats were subcutaneously implanted with an osmotic minipumps and randomly divided into four groups: control; aldosterone (1 μg/h); aldosterone plus a specific MR antagonist, eplerenone (100 mg/kg/day); and aldosterone plus a vasodilator, hydralazine (25 mg/kg/day). After 8 weeks of infusion, aortic smooth muscle cell proliferation and collagen deposition, as well as the MDM2 and TGF-β1 expression levels in the aorta, were examined. Model rats with APAs were successfully constructed. Compared with the control rats, the model rats exhibited (1) marked SBP elevation, (2) no significant alteration in aortic morphology, (3) increased VSMC proliferation and MDM2 expression in the aorta, and (4) enhanced total collagen and collagen III depositions in the aorta, accompanied with up-regulated expression of TGF-β1. These effects were significantly inhibited by co-administration with eplerenone but not with hydralazine. These findings suggested that specific MR antagonism protects the aorta from aldosterone-induced VSMC proliferation and collagen deposition.
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Affiliation(s)
- Yongji Yan
- Department of Urology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, People's Republic of China.,Department of Urology, East Section of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Chao Wang
- Department of Urology, First People's Hospital of Jining City, Jining, Shandong Province, People's Republic of China
| | - Yiqin Lu
- Department of Gynecology, First People's Hospital of Yunnan Province, Kunming, Yunnan Province, People's Republic of China
| | - Huijie Gong
- Department of Urology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, People's Republic of China.,Department of Urology, East Section of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Zhun Wu
- Department of Urology, First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, People's Republic of China
| | - Xin Ma
- Department of Urology, Chinese People's Liberation Army General Hospital, Military Postgraduate Medical College, 28 Fu Xing Road, Hai Dian District, Beijing, 100853, People's Republic of China
| | - Hongzhao Li
- Department of Urology, Chinese People's Liberation Army General Hospital, Military Postgraduate Medical College, 28 Fu Xing Road, Hai Dian District, Beijing, 100853, People's Republic of China
| | - Baojun Wang
- Department of Urology, Chinese People's Liberation Army General Hospital, Military Postgraduate Medical College, 28 Fu Xing Road, Hai Dian District, Beijing, 100853, People's Republic of China
| | - Xu Zhang
- Department of Urology, Chinese People's Liberation Army General Hospital, Military Postgraduate Medical College, 28 Fu Xing Road, Hai Dian District, Beijing, 100853, People's Republic of China.
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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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25
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Liang Y, Wang J, Gao H, Wang Q, Zhang J, Qiu J. Beneficial effects of grape seed proanthocyanidin extract on arterial remodeling in spontaneously hypertensive rats via protecting against oxidative stress. Mol Med Rep 2016; 14:3711-8. [PMID: 27601315 DOI: 10.3892/mmr.2016.5699] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 08/01/2016] [Indexed: 11/05/2022] Open
Abstract
Arterial remodeling is a pathogenic occurrence during hypertension and, in turn, is closely associated with the development and complications of hypertension. Grape seed proanthocyanidin extract (GSPE) has been reported to exhibit a protective effect on cardiovascular disease, however its effect on arterial remodeling remains to be fully elucidated. In the present study, the effects of GSPE on arterial remodeling were analyzed by treating spontaneously hypertensive rats (SHRs) with GSPE (250 mg/kg·day). Arterial remodeling was quantified through morphological methods; thoracic aortas were stained with hematoxylin-eosin or sirius red‑victoria blue. The arterial ultrastructure was imaged using transmission electron microscopy. The content of nitric oxide (NO) and endothelin‑1 (ET‑1) were examined to determine endothelial function. Oxidative stress was assessed by malondialdehyde (MDA) levels and the activities of the antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT). Administration of GSPE markedly alleviated hypertension‑induced arterial remodeling, which was not associated with blood pressure control. ET‑1 production was reduced, while NO production was increased in the GSPE group, which exhibited improved endothelial function. In addition, treatment with GSPE significantly ameliorated oxidative stress by improving SOD and CAT activities and reducing MDA formation. In conclusion, GSPE may attenuate hypertension‑induced arterial remodeling by repressing oxidative stress and is recommended as a potential anti‑arterial remodeling agent for patients with hypertensive vascular diseases.
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Affiliation(s)
- Ying Liang
- Department of Geriatric Cardiology, Qianfoshan Hospital of Shandong University, Jinan, Shandong 250013, P.R. China
| | - Jian Wang
- Department of Geriatric Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Haiqing Gao
- Department of Geriatric Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Quanzhen Wang
- Department of Geriatric Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Jun Zhang
- Department of Geriatric Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Jie Qiu
- Department of Geriatric Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Stowasser M, Young WF. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016; 101:1889-916. [PMID: 26934393 DOI: 10.1210/jc.2015-4061] [Citation(s) in RCA: 1610] [Impact Index Per Article: 201.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To develop clinical practice guidelines for the management of patients with primary aldosteronism. PARTICIPANTS The Task Force included a chair, selected by the Clinical Guidelines Subcommittee of the Endocrine Society, six additional experts, a methodologist, and a medical writer. The guideline was cosponsored by American Heart Association, American Association of Endocrine Surgeons, European Society of Endocrinology, European Society of Hypertension, International Association of Endocrine Surgeons, International Society of Endocrinology, International Society of Hypertension, Japan Endocrine Society, and The Japanese Society of Hypertension. The Task Force received no corporate funding or remuneration. EVIDENCE We searched for systematic reviews and primary studies to formulate the key treatment and prevention recommendations. We used the Grading of Recommendations, Assessment, Development, and Evaluation group criteria to describe both the quality of evidence and the strength of recommendations. We used "recommend" for strong recommendations and "suggest" for weak recommendations. CONSENSUS PROCESS We achieved consensus by collecting the best available evidence and conducting one group meeting, several conference calls, and multiple e-mail communications. With the help of a medical writer, the Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and Council successfully reviewed the drafts prepared by the Task Force. We placed the version approved by the Clinical Guidelines Subcommittee and Clinical Affairs Core Committee on the Endocrine Society's website for comments by members. At each stage of review, the Task Force received written comments and incorporated necessary changes. CONCLUSIONS For high-risk groups of hypertensive patients and those with hypokalemia, we recommend case detection of primary aldosteronism by determining the aldosterone-renin ratio under standard conditions and recommend that a commonly used confirmatory test should confirm/exclude the condition. We recommend that all patients with primary aldosteronism undergo adrenal computed tomography as the initial study in subtype testing and to exclude adrenocortical carcinoma. We recommend that an experienced radiologist should establish/exclude unilateral primary aldosteronism using bilateral adrenal venous sampling, and if confirmed, this should optimally be treated by laparoscopic adrenalectomy. We recommend that patients with bilateral adrenal hyperplasia or those unsuitable for surgery should be treated primarily with a mineralocorticoid receptor antagonist.
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Affiliation(s)
- John W Funder
- Hudson Institute of Medical Research (J.W.F.), Clayton, VIC 3168, Australia; University of Virginia Health System (R.M.C.), Charlottesville, Virginia 22908; University of Padova (F.M.), 35122 Padua, Italy; Mayo Clinic, Evidence-based Practice Center (M.H.M.), Rochester, Minnesota 55905; Klinikum of the Ludwig-Maximilians-University of Munich (M.R.), 80366 München, Bavaria, Germany; Oita University (H.S.), Oita 870-1124, Japan; University of Queensland (M.S.), Brisbane, Australia; and Mayo Clinic (W.F.Y.), Rochester, Minnesota 55905
| | - Robert M Carey
- Hudson Institute of Medical Research (J.W.F.), Clayton, VIC 3168, Australia; University of Virginia Health System (R.M.C.), Charlottesville, Virginia 22908; University of Padova (F.M.), 35122 Padua, Italy; Mayo Clinic, Evidence-based Practice Center (M.H.M.), Rochester, Minnesota 55905; Klinikum of the Ludwig-Maximilians-University of Munich (M.R.), 80366 München, Bavaria, Germany; Oita University (H.S.), Oita 870-1124, Japan; University of Queensland (M.S.), Brisbane, Australia; and Mayo Clinic (W.F.Y.), Rochester, Minnesota 55905
| | - Franco Mantero
- Hudson Institute of Medical Research (J.W.F.), Clayton, VIC 3168, Australia; University of Virginia Health System (R.M.C.), Charlottesville, Virginia 22908; University of Padova (F.M.), 35122 Padua, Italy; Mayo Clinic, Evidence-based Practice Center (M.H.M.), Rochester, Minnesota 55905; Klinikum of the Ludwig-Maximilians-University of Munich (M.R.), 80366 München, Bavaria, Germany; Oita University (H.S.), Oita 870-1124, Japan; University of Queensland (M.S.), Brisbane, Australia; and Mayo Clinic (W.F.Y.), Rochester, Minnesota 55905
| | - M Hassan Murad
- Hudson Institute of Medical Research (J.W.F.), Clayton, VIC 3168, Australia; University of Virginia Health System (R.M.C.), Charlottesville, Virginia 22908; University of Padova (F.M.), 35122 Padua, Italy; Mayo Clinic, Evidence-based Practice Center (M.H.M.), Rochester, Minnesota 55905; Klinikum of the Ludwig-Maximilians-University of Munich (M.R.), 80366 München, Bavaria, Germany; Oita University (H.S.), Oita 870-1124, Japan; University of Queensland (M.S.), Brisbane, Australia; and Mayo Clinic (W.F.Y.), Rochester, Minnesota 55905
| | - Martin Reincke
- Hudson Institute of Medical Research (J.W.F.), Clayton, VIC 3168, Australia; University of Virginia Health System (R.M.C.), Charlottesville, Virginia 22908; University of Padova (F.M.), 35122 Padua, Italy; Mayo Clinic, Evidence-based Practice Center (M.H.M.), Rochester, Minnesota 55905; Klinikum of the Ludwig-Maximilians-University of Munich (M.R.), 80366 München, Bavaria, Germany; Oita University (H.S.), Oita 870-1124, Japan; University of Queensland (M.S.), Brisbane, Australia; and Mayo Clinic (W.F.Y.), Rochester, Minnesota 55905
| | - Hirotaka Shibata
- Hudson Institute of Medical Research (J.W.F.), Clayton, VIC 3168, Australia; University of Virginia Health System (R.M.C.), Charlottesville, Virginia 22908; University of Padova (F.M.), 35122 Padua, Italy; Mayo Clinic, Evidence-based Practice Center (M.H.M.), Rochester, Minnesota 55905; Klinikum of the Ludwig-Maximilians-University of Munich (M.R.), 80366 München, Bavaria, Germany; Oita University (H.S.), Oita 870-1124, Japan; University of Queensland (M.S.), Brisbane, Australia; and Mayo Clinic (W.F.Y.), Rochester, Minnesota 55905
| | - Michael Stowasser
- Hudson Institute of Medical Research (J.W.F.), Clayton, VIC 3168, Australia; University of Virginia Health System (R.M.C.), Charlottesville, Virginia 22908; University of Padova (F.M.), 35122 Padua, Italy; Mayo Clinic, Evidence-based Practice Center (M.H.M.), Rochester, Minnesota 55905; Klinikum of the Ludwig-Maximilians-University of Munich (M.R.), 80366 München, Bavaria, Germany; Oita University (H.S.), Oita 870-1124, Japan; University of Queensland (M.S.), Brisbane, Australia; and Mayo Clinic (W.F.Y.), Rochester, Minnesota 55905
| | - William F Young
- Hudson Institute of Medical Research (J.W.F.), Clayton, VIC 3168, Australia; University of Virginia Health System (R.M.C.), Charlottesville, Virginia 22908; University of Padova (F.M.), 35122 Padua, Italy; Mayo Clinic, Evidence-based Practice Center (M.H.M.), Rochester, Minnesota 55905; Klinikum of the Ludwig-Maximilians-University of Munich (M.R.), 80366 München, Bavaria, Germany; Oita University (H.S.), Oita 870-1124, Japan; University of Queensland (M.S.), Brisbane, Australia; and Mayo Clinic (W.F.Y.), Rochester, Minnesota 55905
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ŠOMLÓOVÁ Z, PETRÁK O, ROSA J, ŠTRAUCH B, INDRA T, ZELINKA T, HALUZÍK M, ZIKÁN V, HOLAJ R, WIDIMSKÝ J. Inflammatory Markers in Primary Aldosteronism. Physiol Res 2016; 65:229-37. [DOI: 10.33549/physiolres.932994] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Primary aldosteronism (PA) is the most common cause of endocrine hypertension with a high frequency of cardiovascular complications. The unfavorable cardiometabolic profile may be due to aldosterone-mediated activation of inflammatory cells, circulatory cytokines and activation of collagen synthesis in the vessel wall. Aim of our study was to evaluate differences in the levels of hsCRP, IL-6, TNF-α and N-terminal propeptide of collagen I (PINP) in patients with PA and essential hypertension (EH) as a control group, and between the subtypes of PA (aldosterone producing adenoma – APA, idiopathic hyperaldosteronism – IHA). We studied 28 patients with PA (IHA – 10 patients, APA – 12 patients, 6 unclassified) and 28 matched patients with EH. There were no differences in the levels of inflammatory markers between the followed groups [EH vs. PA: TNF-α (5.09 [3.68-6.32] vs. 4.84 [3.62-6.50] pg/ml), IL-6 (0.94 [0.70-1.13] vs. 0.97 [0.71-1.28] pg/ml), hsCRP (0.53 [0.25-1.54] vs. 0.37 [0.31-0.61] mg/l), leukocytes (6.35±1.42 vs. 5.97±1.29 109 l); APA vs. IHA: TNF-α (4.54 [3.62-7.03] vs. 5.19 [4.23-5.27] pg/ml), IL-6 (0.96 [0.63-1.21] vs. 0.90 [0.65-1.06] pg/ml), hsCRP (0.34 [0.29-0.47] vs. 0.75 [0.36-1.11] mg/l), leukocytes (6.37±1.41 vs. 5.71±1.21 109 l)]. Significant differences in the levels of PINP between PA and EH group were observed (35.18 [28.46-41.16] vs. 45.21 [36.95-62.81] μg/l, p≤0.003). No differences in inflammatory markers were observed between the followed groups, we confirmed higher levels of PINP in patients with PA.
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Affiliation(s)
- Z. ŠOMLÓOVÁ
- Third Department of Internal Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Rodella LF, Rezzani R, Bonomini F, Peroni M, Cocchi MA, Hirtler L, Bonardelli S. Abdominal aortic aneurysm and histological, clinical, radiological correlation. Acta Histochem 2016; 118:256-62. [PMID: 26858185 DOI: 10.1016/j.acthis.2016.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 01/26/2016] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
To date, the pathogenesis of abdominal aortic aneurism (AAA) still remains unclear. As such, the aim of this study was to evaluate changes of the aortic structure during AAA. We analysed the microscopic frame of vessels sections, starting from the primum movens leading to abnormal dilatation. AAA samples were collected and processed through various staining methods (Verhoeff-Van Gieson, Masson Goldner, Sirius Red). Subsequently, the vessel morphology and collagenic web of the tunica media and adventitia were determined and the amount of type I and type III collagen was measured. We also applied immune-histochemistry markers for CD34 and PGP 9.5 in order to identify vascular and nerve structures in the aorta. Immune-positivity quantification was used to calculate the percentage of the stained area. We found increasing deposition of type I collagen and reduced type III collagen in both tunica media and adventitia of AAA. The total amount of vasa vasorum, marked with CD34, and nerva vasorum, marked with PGP 9.5, was also higher in AAA samples. Cardiovascular risk factors (blood pressure, dyslipidemia, cigarette smoking) and radiological data (maximum aneurism diameter, intra-luminal thrombus, aortic wall calcification) increased these changes. These results suggest that the tunica adventitia may have a central role in the pathogenesis of AAA as clearly there are major changes characterized by rooted inflammatory infiltration. The presence of immune components could explain these modifications within the framework of the aorta.
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The hypertension of Cushing's syndrome: controversies in the pathophysiology and focus on cardiovascular complications. J Hypertens 2016; 33:44-60. [PMID: 25415766 PMCID: PMC4342316 DOI: 10.1097/hjh.0000000000000415] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cushing's syndrome is associated with increased mortality, mainly due to cardiovascular complications, which are sustained by the common development of systemic arterial hypertension and metabolic syndrome, which partially persist after the disease remission. Cardiovascular diseases and hypertension associated with endogenous hypercortisolism reveal underexplored peculiarities. The use of exogenous corticosteroids also impacts on hypertension and cardiovascular system, especially after prolonged treatment. The mechanisms involved in the development of hypertension differ, whether glucocorticoid excess is acute or chronic, and the source endogenous or exogenous, introducing inconsistencies among published studies. The pleiotropic effects of glucocorticoids and the overlap of the several regulatory mechanisms controlling blood pressure suggest that a rigorous comparison of in-vivo and in-vitro studies is necessary to draw reliable conclusions. This review, developed during the first ‘Altogether to Beat Cushing's syndrome’ workshop held in Capri in 2012, evaluates the most important peculiarities of hypertension associated with CS, with a particular focus on its pathophysiology. A critical appraisal of most significant animal and human studies is compared with a systematic review of the few available clinical trials. A special attention is dedicated to the description of the clinical features and cardiovascular damage secondary to glucocorticoid excess. On the basis of the consensus reached during the workshop, a pathophysiology-oriented therapeutic algorithm has been developed and it could serve as a first attempt to rationalize the treatment of hypertension in Cushing's syndrome.
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Time course and factors predicting arterial stiffness reversal in patients with aldosterone-producing adenoma after adrenalectomy: prospective study of 102 patients. Sci Rep 2016; 6:20862. [PMID: 26883298 PMCID: PMC4756682 DOI: 10.1038/srep20862] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/08/2016] [Indexed: 12/03/2022] Open
Abstract
Primary aldosteronism not only results in hypertension but also stiffer arteries. The time course and factors predicting the reversal of arterial stiffness after treatment are unclear. We prospectively enrolled 102 patients with aldosterone-producing adenoma (APA) from March 2006 to January 2012. We measured the pulse wave velocity (PWV) between brachial-ankle (baPWV) and heart-ankle (haPWV) before, 6 and 12 months after their adrenalectomy. After treatment, the PWV decreased significantly during the first 6 months (both p < 0.001), but no further reduction in the following 6 months. The determinant factors for baseline baPWV were age, duration of hypertension, and baseline systolic blood pressure (SBP) in multivariate linear regression analysis, similar with baseline haPWV (determinants: age, duration of hypertension, baseline SBP and diastolic blood pressure (DBP)). In multivariate linear regression analysis, the decrease in DBP at 6 months (ΔDBP0-6mo) and baseline baPWV were significantly associated with the decrease in baPWV at 6 months (ΔbaPWV0-6mo). The associated factors of the change in haPWV at 6 months (ΔhaPWV0-6mo) were baseline haPWV, ΔDBP0-6mo and change in log-transformed plasma renin activity. Our result suggested that reversal of arterial stiffness in APA patients occurred early after adrenalectomy and determined by baseline vascular condition, hemodynamic factors, and humoral factors.
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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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Belo VA, Guimarães DA, Castro MM. Matrix Metalloproteinase 2 as a Potential Mediator of Vascular Smooth Muscle Cell Migration and Chronic Vascular Remodeling in Hypertension. J Vasc Res 2016; 52:221-31. [PMID: 26731549 DOI: 10.1159/000441621] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/10/2015] [Indexed: 11/19/2022] Open
Abstract
For vascular remodeling in hypertension, it is essential that vascular smooth muscle cells (VSMCs) reshape in order to proliferate and migrate. The extracellular matrix (ECM) needs to be degraded to favor VSMC migration. Many proteases, including matrix metalloproteinases (MMPs), contribute to ECM proteolysis and VSMC migration. Bioactive peptides, hemodynamic forces and reactive oxygen-nitrogen species regulate MMP-2 expression and activity. Increased MMP-2 activity contributes to hypertension-induced maladaptive arterial changes and sustained hypertension. New ECM is synthesized to supply VSMCs with bioactive mediators, which stimulate hypertrophy. MMP-2 stimulates the interaction of VSMCs with newly formed ECM, which triggers intracellular signaling via integrins to induce a phenotypic switch and persistent migration. VSMCs switch from a contractile to a synthetic phenotype in order to migrate and contribute to vascular remodeling in hypertension. MMPs also disrupt growth factors bound to ECM, thus contributing to their capacity to regulate VSMC migration. This review sheds light on the proteolytic effects of MMP-2 on ECM and non-ECM substrates in the vasculature and how these effects contribute to VSMC migration in hypertension. The inhibition of MMP activity as a therapeutic target may make it possible to reduce arterial maladaptation caused by hypertension and prevent the resulting fatal cardiovascular events.
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Affiliation(s)
- V A Belo
- Department of Pharmacology, Faculty of Medicine of Ribeirao Preto, University of Sx00E3;o Paulo, Ribeirao Preto, Brazil
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Matsuda Y, Kawate H, Matsuzaki C, Sakamoto R, Shibue K, Ohnaka K, Anzai K, Nomura M, Takayanagi R. Eplerenone improves carotid intima-media thickness (IMT) in patients with primary aldosteronism. Endocr J 2016; 63:249-55. [PMID: 26727302 DOI: 10.1507/endocrj.ej15-0362] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Primary aldosteronism (PA) is associated with a higher rate of cardiovascular events than essential hypertension. Although adrenalectomy has been reported to reduce carotid intima-media thickness (IMT) in patients with PA, the effects of the selective aldosterone blocker, eplerenone, on vascular damage in these patients remains unclear. To evaluate the effects of eplerenone on vascular status in PA patients, we sequentially measured carotid IMT (using computer software to calculate an average IMT for accurate and reproducible evaluation) in 22 patients including 8 patients treated by unilateral adrenalectomy and 14 patients treated with eplerenone for 12 months. Patients who underwent adrenalectomy showed significant reductions in aldosterone concentration (from 345 ± 176 pg/mL to 67 ± 34 pg/mL; P<0.01) and IMT (from 0.67 ± 0.07 mm to 0.63 ± 0.09 mm; P<0.05) 6 months after surgery. Patients treated with eplerenone showed significant reductions in IMT from baseline (0.75 ± 0.10 mm) to 6 (0.71 ± 0.11 mm; P<0.05) and 12 (0.65 ± 0.09 mm; P<0.01) months, although plasma aldosterone level increased significantly, from 141 ± 105 pg/mL to 207 ± 98 pg/mL (P<0.05). Eplerenone treatment of patients with PA reduces blood pressure, increases serum potassium level, and improves vascular status. Carotid IMT may be a useful marker for evaluating the effectiveness of eplerenone in patients with PA.
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Affiliation(s)
- Yayoi Matsuda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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Prejbisz A, Warchoł-Celińska E, Lenders JWM, Januszewicz A. Cardiovascular Risk in Primary Hyperaldosteronism. Horm Metab Res 2015; 47:973-80. [PMID: 26575306 DOI: 10.1055/s-0035-1565124] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
After the first cases of primary aldosteronism were described and characterized by Conn, a substantial body of experimental and clinical evidence about the long-term effects of excess aldosterone on the cardiovascular system was gathered over the last 5 decades. The prevalence of primary aldosteronism varies considerably between different studies among hypertensive patients, depending on patient selection, the used diagnostic methods, and the severity of hypertension. Prevalence rates vary from 4.6 to 16.6% in those studies in which confirmatory tests to diagnose primary aldosteronism were used. There is also growing evidence indicating that prolonged exposure to elevated aldosterone concentrations is associated with target organ damage in the heart, kidney, and arterial wall, and high cardiovascular risk in patients with primary aldosteronism. Therefore, the aim of treatment should not be confined to BP normalization and hypokalemia correction, but rather should focus on restoring the deleterious effects of excess aldosterone on the cardiovascular system. Current evidence convincingly demonstrates that both surgical and medical treatment strategies beneficially affect cardiovascular outcomes and mortality in the long term. Further studies can be expected to provide better insight into the relationship between cardiovascular risk and complications and the genetic background of primary aldosteronism.
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Affiliation(s)
- A Prejbisz
- Department of Hypertension, Institute of Cardiology, Warsaw, Poland
| | | | - J W M Lenders
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Januszewicz
- Department of Hypertension, Institute of Cardiology, Warsaw, Poland
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Abstract
Primary aldosteronism (PA) is the main cause of endocrine hypertension, present in approximately 10% of hypertensive patients; about one-third is secondary to aldosterone-producing adenomas. Cardiovascular and renal morbidity are out of proportion to the degree of hypertension. Physicians have compelling rationale to correctly identify and treat PA. Physicians are challenged with patient selection for screening with the aldosterone/renin ratio (ARR), interpretation of ARR, and selecting a confirmatory test. Adrenal vein sampling is performed for subtype differentiation. The treatment depends on the disease subtype and results in control of hypertension and reversal of associated excess morbidity.
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Rizzoni D, De Ciuceis C, Salvetti M, Paini A, Rossini C, Agabiti-Rosei C, Muiesan ML. Interactions between macro- and micro-circulation: are they relevant? High Blood Press Cardiovasc Prev 2015; 22:119-28. [PMID: 25870123 DOI: 10.1007/s40292-015-0086-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 03/27/2015] [Indexed: 01/12/2023] Open
Abstract
Macrovasculature, microvasculature, and the heart are the main determinants of the structure and function of the circulatory system. Due to viscoelastic properties of large arteries, the pulsatile pressure and flow that result from intermittent ventricular ejection are smoothed out, so that microvasculature mediates steadily the delivery of nutrients and oxygen to tissues. The disruption of this function, which occurs when microvascular structure develops, mainly in response to hypertension, leads to end-organ damage. Microvascular structure is not only the site of vascular resistance but probably also the origin of most of the wave reflections generating increased central systolic blood pressure in the elderly. Many data of the literature suggest that hypertension-related damage to the micro and macrovascular system may be corrected by pharmacological agents. Among them, β-blocking agents and diuretics have a negligible effect on microvascular structure, while renin-angiotensin system antagonists and calcium entry blockers have favorable actions, improving large artery mechanics and possibly reducing central wave reflections. Central pulse pressure, indicative of changes in large conduit arteries is an independent determinant of vascular remodelling in small resistance arteries and might represent a main target of antihypertensive treatment.
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Affiliation(s)
- Damiano Rizzoni
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2ª Medicina, Spedali Civili, 25100, Brescia, Italy,
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Indra T, Holaj R, Štrauch B, Rosa J, Petrák O, Šomlóová Z, Widimský J. Long-term effects of adrenalectomy or spironolactone on blood pressure control and regression of left ventricle hypertrophy in patients with primary aldosteronism. J Renin Angiotensin Aldosterone Syst 2014; 16:1109-17. [PMID: 25271250 DOI: 10.1177/1470320314549220] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 07/25/2014] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Primary aldosteronism (PA) represents the most common cause of secondary hypertension. Beyond increased blood pressure, additional harmful effects of aldosterone excess including inappropriate left ventricle (LV) hypertrophy were found. We evaluated the effect of adrenalectomy and spironolactone on blood pressure and myocardial remodelling in a long-term follow-up study. METHODS Thirty-one patients with PA were recruited. Fifteen patients with confirmed aldosterone-producing adenoma underwent adrenalectomy; in the remaining 16 patients, treatment with spironolactone was initiated. Laboratory data, 24-hour ambulatory blood pressure monitoring (ABPM) and echocardiography parameters were evaluated at baseline and at a median follow-up of 64 months. RESULTS Both approaches reduced blood pressure (p = 0.001 vs. baseline). In both groups we observed a decrease in end-diastolic (p = 0.04, p = 0.01) and end-systolic LV cavity diameters (p = 0.03, p = 0.01). Interventricular septum and posterior wall thickness reduction was significant only after adrenalectomy (p = 0.01, p = 0.03) as was reduction of LV mass index (p = 0.004). A trend to lower LV mass on spironolactone was caused predominantly by diminution of the LV cavity, which was reflected in increased relative wall thickness (p = 0.05). CONCLUSIONS Although both surgical and conservative treatment can induce a long-term decrease of blood pressure, adrenalectomy seems to be more effective in reduction of LV mass, as it reverses both wall thickening and enlargement of the LV cavity.
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Affiliation(s)
- Tomáš Indra
- Third Department of Internal Medicine, General University Hospital, Prague, Czech Republic; and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Robert Holaj
- Third Department of Internal Medicine, General University Hospital, Prague, Czech Republic; and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Branislav Štrauch
- Third Department of Internal Medicine, General University Hospital, Prague, Czech Republic; and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ján Rosa
- Third Department of Internal Medicine, General University Hospital, Prague, Czech Republic; and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ondřej Petrák
- Third Department of Internal Medicine, General University Hospital, Prague, Czech Republic; and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zuzana Šomlóová
- Third Department of Internal Medicine, General University Hospital, Prague, Czech Republic; and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Widimský
- Third Department of Internal Medicine, General University Hospital, Prague, Czech Republic; and First Faculty of Medicine, Charles University, Prague, Czech Republic
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Catena C, Colussi G, Sechi LA. Aldosterone, organ damage and dietary salt. Clin Exp Pharmacol Physiol 2013; 40:922-8. [DOI: 10.1111/1440-1681.12145] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 06/17/2013] [Accepted: 06/21/2013] [Indexed: 01/29/2023]
Affiliation(s)
- Cristiana Catena
- Hypertension Unit; Internal Medicine; Department of Experimental and Clinical Medical Science; University of Udine; Udine Italy
| | - GianLuca Colussi
- Hypertension Unit; Internal Medicine; Department of Experimental and Clinical Medical Science; University of Udine; Udine Italy
| | - Leonardo A Sechi
- Hypertension Unit; Internal Medicine; Department of Experimental and Clinical Medical Science; University of Udine; Udine Italy
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Galati SJ, Hopkins SM, Cheesman KC, Zhuk RA, Levine AC. Primary aldosteronism: emerging trends. Trends Endocrinol Metab 2013; 24:421-30. [PMID: 23796656 DOI: 10.1016/j.tem.2013.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 01/07/2023]
Abstract
Primary aldosteronism (PA) is the most common etiology of endocrine hypertension (HTN), and recent prevalence studies suggest that it may be under-diagnosed. Indications for screening have been expanded with recognition that many patients with PA do not have hypokalemia and that the disease may be familial. The aldosterone:renin ratio (ARR) is the preferred screening test for PA. The ARR can be interpreted in patients on most anti-hypertensive agents, and can be used to guide medical therapy of HTN even in patients without PA. Once PA is confirmed, adrenal venous sampling (AVS) should be performed to determine if PA is due to bilateral disease or a unilateral adenoma, if surgery is being considered. Targeted medical or surgical therapy improves patient outcomes.
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Affiliation(s)
- Sandi-Jo Galati
- Division of Endocrinology, Metabolism and Bone Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, Adrenal Center at Mount Sinai Hospital, 1 Gustave L. Levy Place, #1055, New York, NY 10029, USA
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Alterations in vascular function in primary aldosteronism: a cardiovascular magnetic resonance imaging study. J Hum Hypertens 2013; 28:92-7. [DOI: 10.1038/jhh.2013.70] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/13/2013] [Accepted: 06/28/2013] [Indexed: 12/11/2022]
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A simple dot-blot-Sirius red-based assay for collagen quantification. Anal Bioanal Chem 2013; 405:6863-71. [PMID: 23780225 DOI: 10.1007/s00216-013-7101-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 05/24/2013] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
Abstract
The assessment of collagen content in tissues is important in biomedical research, since this protein is altered in numerous diseases. Hydroxyproline and Sirius red based assays are the most common methods for collagen quantification. However, these procedures have some pitfalls, such as the requirement of oxygen-free medium or expensive equipment and large sample size or being unsuitable for hydrolyzed collagen, respectively. Our objective was to develop a specific, versatile, and user-friendly quantitative method applicable to small tissue samples and extracts obtained from elastin purification, therefore, suitable for simultaneous quantification of elastin. This method is based on the binding of Sirius red to collagen present in a sample immobilized on a PVDF membrane, as in the dot-blot technique, and quantified by a scanner and image analysis software. Sample loading, Sirius red concentration, temperature and incubation time, type of standard substance, albumin interference, and quantification time are optimized. The method enabled the quantification of (1) intact collagen in several rat tissue homogenates, including small resistance-sized arteries, (2) partially hydrolyzed collagen obtained from NaOH extracts, compatible with elastin purification, and (3) for the detection of differences in collagen content between hypertensive and normotensive rats. We conclude that the developed technique can be widely used since it is versatile (quantifies intact and hydrolyzed collagen), requires small sample volumes, is user-friendly (low-cost, easy to use, minimum toxic materials, and reduced time of test), and is specific (minimal interference with serum albumin).
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Gregori M, Tocci G, Marra A, Pignatelli G, Santolamazza C, Befani A, Ciavarella GM, Ferrucci A, Paneni F. Inadequate RAAS suppression is associated with excessive left ventricular mass and systo-diastolic dysfunction. Clin Res Cardiol 2013; 102:725-33. [PMID: 23765436 DOI: 10.1007/s00392-013-0585-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 05/31/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Inadequate suppression of renin-angiotensin-aldosterone system (RAAS) following postural maneuvers may have detrimental effects on cardiac structure and function. In this study, we aimed to appraise the clinical significance of this phenomenon by assessing its relation with inappropriate ventricular mass (ILVM), an adverse phenotype of LV remodeling and dysfunction. METHODS Both supine and upright plasma renin activity (PRA) and aldosterone concentrations (PAC) were measured in 115 young newly diagnosed hypertensive subjects. 24-h ambulatory blood pressure monitoring and echocardiographic evaluation including tissue Doppler imaging (TDI) were also performed. Patients were divided as follows: (1) normal PRA and PAC (N) (n = 63); (2) suppressible RAAS (SR) in supine position (n = 27); (3) not suppressible RAAS (NSR) (n = 25). ILVM was expressed as the observed/predicted LV mass ratio ×100 (%PLVM), while LV dysfunction (LVD) was identified by TDI-derived myocardial performance index (MPI). RESULTS NSR showed a higher prevalence of ILVM than SR and N. As compared with N and SR, NSR patients had reduced indices of systolic and diastolic function. MPI of the LV as well as prevalence of LVD was also significantly higher in the NSR group. Regression models showed that lack of RAAS suppression was independently associated with ILVM and LVD. CONCLUSIONS Prevalence of ILVM and LVD is higher in patients without clinostatic RAAS suppression. Our findings encourage the assessment of RAAS deregulation to better estimate individual cardiovascular risk in patients with arterial hypertension.
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Affiliation(s)
- Mario Gregori
- Cardiology Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Via di Grottarossa, 1035-1039, Rome, Italy,
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43
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Muiesan ML, Salvetti M, Rizzoni D, Paini A, Agabiti-Rosei C, Aggiusti C, Agabiti Rosei E. Resistant hypertension and target organ damage. Hypertens Res 2013; 36:485-91. [PMID: 23595044 DOI: 10.1038/hr.2013.30] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cardiovascular (CV) complications such as myocardial infarction, heart failure, stroke and renal failure are related to both the degree and the duration of blood pressure (BP) increase. Resistant hypertension (RH) is associated with a higher risk of CV complications and a higher prevalence of target organ damage (TOD). The relationship between CV disease and TOD can be bidirectional. Elevated BP in RH may cause CV structural and functional alterations, and the development or persistence of left ventricular hypertrophy, aortic stiffness, atherosclerotic plaques, microvascular disease and renal dysfunction, may render hypertension more difficult to control. Specifically, RH is related to several conditions, including obesity, sleep apnea, diabetes, metabolic syndrome and hyperaldosteronism, characterized by an overexpression of humoral and hormonal factors that are involved in the development and maintenance of TOD. Optimal therapeutic strategies, including pharmacological treatment and innovative invasive methodologies, have been shown to achieve adequate BP control and induce the regression of TOD, thereby potentially improving patient prognosis.
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Affiliation(s)
- Maria Lorenza Muiesan
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
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44
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Apolipoprotein E deficiency and a mouse model of accelerated liver aging. Biogerontology 2013; 14:209-20. [DOI: 10.1007/s10522-013-9424-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 04/10/2013] [Indexed: 10/27/2022]
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45
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Freel EM, Mark PB, Weir RA, McQuarrie EP, Allan K, Dargie HJ, McClure JD, Jardine AG, Davies E, Connell JM. Demonstration of Blood Pressure-Independent Noninfarct Myocardial Fibrosis in Primary Aldosteronism. Circ Cardiovasc Imaging 2012; 5:740-7. [DOI: 10.1161/circimaging.112.974576] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background—
Primary aldosteronism (PA) is common and associates with excess cardiovascular morbidity independent of blood pressure. Exposure to aldosterone and sodium leads to cardiac fibrosis and hypertrophy in humans and animals possibly mediated by inflammation and oxidative stress. We aimed to clarify the effects of aldosterone excess on myocardial structure and composition in human subjects with PA and essential hypertension using contrast-enhanced cardiac magnetic resonance imaging as well as explore the mechanistic basis for any observed differences.
Methods and Results—
Twenty-seven subjects with recently diagnosed PA and 54 essential hypertension controls were recruited. Subjects underwent gadolinium-enhanced cardiac magnetic resonance; noninfarct related myocardial fibrosis was identified by a diffuse pattern of late gadolinium enhancement. Patients also underwent assessment of pulse wave velocity, measurement of circulating superoxide anion and C-reactive protein, as well as blood pressure and biochemical assessment. Subjects were well matched with no difference in severity or duration of hypertension. There was a significant increase in the frequency of noninfarct late gadolinium enhancement in PA (70%) when compared with essential hypertension subjects (13%;
P
<0.0001) with no difference in left ventricular mass. Pulse wave velocity, superoxide, and C-reactive protein were significantly higher in subjects with PA.
Conclusions—
These data illustrate that patients with PA exhibit frequent myocardial fibrosis as demonstrated by late gadolinium enhancement using cardiac magnetic resonance imaging; this finding is independent of blood pressure. This may be mediated partly through inflammation and oxidative stress. This study highlights the importance of specific targeting of aldosterone excess as well as blood pressure reduction to minimize cardiac morbidity in PA.
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Affiliation(s)
- E. Marie Freel
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (E.M.F., P.B.M., E.P.M.Q., K.A., H.J.D., J.D.M.C., A.G.J., E.D.); Department of Cardiology, Hairmyres Hospital, East Kilbride, Glasgow, United Kingdom (R.A.P.W.); and Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom (J.M.C.C.)
| | - Patrick B. Mark
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (E.M.F., P.B.M., E.P.M.Q., K.A., H.J.D., J.D.M.C., A.G.J., E.D.); Department of Cardiology, Hairmyres Hospital, East Kilbride, Glasgow, United Kingdom (R.A.P.W.); and Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom (J.M.C.C.)
| | - Robin A.P. Weir
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (E.M.F., P.B.M., E.P.M.Q., K.A., H.J.D., J.D.M.C., A.G.J., E.D.); Department of Cardiology, Hairmyres Hospital, East Kilbride, Glasgow, United Kingdom (R.A.P.W.); and Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom (J.M.C.C.)
| | - Emily P. McQuarrie
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (E.M.F., P.B.M., E.P.M.Q., K.A., H.J.D., J.D.M.C., A.G.J., E.D.); Department of Cardiology, Hairmyres Hospital, East Kilbride, Glasgow, United Kingdom (R.A.P.W.); and Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom (J.M.C.C.)
| | - Karen Allan
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (E.M.F., P.B.M., E.P.M.Q., K.A., H.J.D., J.D.M.C., A.G.J., E.D.); Department of Cardiology, Hairmyres Hospital, East Kilbride, Glasgow, United Kingdom (R.A.P.W.); and Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom (J.M.C.C.)
| | - Henry J. Dargie
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (E.M.F., P.B.M., E.P.M.Q., K.A., H.J.D., J.D.M.C., A.G.J., E.D.); Department of Cardiology, Hairmyres Hospital, East Kilbride, Glasgow, United Kingdom (R.A.P.W.); and Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom (J.M.C.C.)
| | - John D. McClure
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (E.M.F., P.B.M., E.P.M.Q., K.A., H.J.D., J.D.M.C., A.G.J., E.D.); Department of Cardiology, Hairmyres Hospital, East Kilbride, Glasgow, United Kingdom (R.A.P.W.); and Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom (J.M.C.C.)
| | - Alan G. Jardine
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (E.M.F., P.B.M., E.P.M.Q., K.A., H.J.D., J.D.M.C., A.G.J., E.D.); Department of Cardiology, Hairmyres Hospital, East Kilbride, Glasgow, United Kingdom (R.A.P.W.); and Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom (J.M.C.C.)
| | - Eleanor Davies
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (E.M.F., P.B.M., E.P.M.Q., K.A., H.J.D., J.D.M.C., A.G.J., E.D.); Department of Cardiology, Hairmyres Hospital, East Kilbride, Glasgow, United Kingdom (R.A.P.W.); and Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom (J.M.C.C.)
| | - John M.C. Connell
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (E.M.F., P.B.M., E.P.M.Q., K.A., H.J.D., J.D.M.C., A.G.J., E.D.); Department of Cardiology, Hairmyres Hospital, East Kilbride, Glasgow, United Kingdom (R.A.P.W.); and Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom (J.M.C.C.)
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ROSA J, ŠOMLÓOVÁ Z, PETRÁK O, ŠTRAUCH B, INDRA T, ŠENITKO M, ZELINKA T, HOLAJ R, WIDIMSKÝ Jr J. Peripheral Arterial Stiffness in Primary Aldosteronism. Physiol Res 2012; 61:461-8. [DOI: 10.33549/physiolres.932344] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aldosterone overproduction increases arterial wall stiffness by accumulation of different types of collagen fibres and growth factors. Our previous studies showed that central (aortic) arterial stiffness is increased in primary aldosteronism (PA) independently of concomitant hypertension and that these changes might be reversible after successful adrenalectomy. There is limited data available on the potential impact of mineralocorticoid overproduction on the deterioration of peripheral arterial stiffness. The current study was thus aimed at investigating the effect of aldosterone overproduction on peripheral arterial stiffness assessed by peripheral (femoral-ankle) pulse wave velocity (PWV) in PA patients compared with essential hypertension (EH) patients. Forty-nine patients with confirmed PA and 49 patients with EH were matched for age, blood pressure, body mass index, lipid profile, and fasting glucose. PWV was obtained using the Sphygmocor applanation tonometer. Both peripheral and central PWV were significantly higher in PA patients compared to EH patients, while clinical blood pressures were similar. Plasma aldosterone level was the main predictor of peripheral PWV in PA. Our data indicate aldosterone overproduction in PA does not preferentially affect central arterial system. Fibroproliferative effect of higher aldosterone levels lead to alteration of central-elastic as well as peripheral-muscular arteries with subsequent increase in its stiffness.
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Affiliation(s)
- J. ROSA
- Third Department of Internal Medicine, General Faculty Hospital, First Medical Faculty, Charles University, Prague
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47
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Sigurjonsdottir HA, Gronowitz M, Andersson O, Eggertsen R, Herlitz H, Sakinis A, Wangberg B, Johannsson G. Unilateral adrenal hyperplasia is a usual cause of primary hyperaldosteronism. Results from a Swedish screening study. BMC Endocr Disord 2012; 12:17. [PMID: 22958674 PMCID: PMC3515501 DOI: 10.1186/1472-6823-12-17] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 08/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The existence of unilateral adrenal hyperplasia (AH) has been considered a rare cause of primary hyperaldosteronism (PA). METHODS In a prospective study we screened for PA in a non-selected (NSP) and selected hypertensive population (SP), to define the cause of PA. We included 353 consecutive patients with hypertension; age 20 to 88 years, 165 women and 188 men, from a university-based Hypertension and Nephrology Outpatient clinics (123 SP) and two primary care centres, (230 NSP) from the same catch-up area. Serum aldosterone and plasma renin activity (PRA) were measured and the ARR calculated. Verifying diagnostic procedure was performed in patients with both elevated aldosterone and ARR. Patients diagnosed with PA were invited for adrenal venous sampling (AVS) and offered laparoscopic adrenalectomy when AVS found the disease to be unilateral. RESULTS After screening, 46 patients, 13% of the whole population (22.8% SP and 7.8% NSP) had aldosterone and ARR above the locally defined cut-off limits (0.43 nmol/l and 1.28 respectively). After diagnostic verification, 20 patients (6%) had PA, (14.5% SP and 1.4% NSP). Imaging diagnostic procedures with CT-scans and scintigraphy were inconclusive. AVS, performed in 15 patients verified bilateral disease in 4 and unilateral in 10 patients. One AVS failed. After laparoscopic adrenalectomy, 4 patients were found to have adenoma and 5 unilateral AH. One patient denied operation. CONCLUSION The prevalence of PA was in agreement with previous studies. The study finds unilateral PA common and unilateral AH as half of those cases. As may be suspected PA is found in much higher frequency in specialised hypertensive units compared to primary care centers. AVS was mandatory in diagnosis of unilateral PA.
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Affiliation(s)
- Helga Agusta Sigurjonsdottir
- Department of Medicine, Centrum of Endocrinology and Metabolism, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | | | - Ove Andersson
- Department of Medicine, Hypertension Outpatient Clinic, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Robert Eggertsen
- Department of Medicine Primary Health Care, Mölnlycke Primary Health Care and Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Hans Herlitz
- Department of Medicine, Nephrology Outpatient Clinic, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Augustinas Sakinis
- Dept of Radiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Bo Wangberg
- Dept of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Gudmundur Johannsson
- Department of Medicine, Centrum of Endocrinology and Metabolism, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
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48
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Reincke M, Fischer E, Gerum S, Merkle K, Schulz S, Pallauf A, Quinkler M, Hanslik G, Lang K, Hahner S, Allolio B, Meisinger C, Holle R, Beuschlein F, Bidlingmaier M, Endres S. Observational Study Mortality in Treated Primary Aldosteronism. Hypertension 2012; 60:618-24. [DOI: 10.1161/hypertensionaha.112.197111] [Citation(s) in RCA: 188] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In comparison with essential hypertension, primary aldosteronism (PA) is associated with an increased risk of cardiovascular morbidity. To date, no data on mortality have been published. We assessed mortality of patients treated for PA within the German Conn's registry and identified risk factors for adverse outcome in a case-control study. Patients with confirmed PA treated in 3 university centers in Germany since 1994 were included in the analysis. All of the patients were contacted in 2009 and 2010 to verify life status. Subjects from the population-based F3 survey of the Cooperative Health Research in the Region of Augsburg served as controls. Final analyses were based on 600 normotensive controls, 600 hypertensive controls, and 300 patients with PA. Kaplan-Meyer survival curves were calculated for both cohorts. Ten-year overall survival was 95% in normotensive controls, 90% in hypertensive controls, and 90% in patients with PA (
P
value not significant). In multivariate analysis, age (hazard ratio, 1.09 per year [95% CI, 1.03–1.14]), angina pectoris (hazard ratio, 3.6 [95% CI, 1.04–12.04]), and diabetes mellitus (hazard ratio, 2.55 [95% CI, 1.07–6.09]) were associated with an increase in all-cause mortality, whereas hypokalemia (hazard ratio, 0.41 per mmol/L [95% CI, 0.17–0.99]) was associated with reduced mortality. Cardiovascular mortality was the main cause of death in PA (50% versus 34% in hypertensive controls;
P
<0.05). These data indicate that cardiovascular mortality is increased in patients treated for PA, whereas all-cause mortality is not different from matched hypertensive controls.
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Affiliation(s)
- Martin Reincke
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Evelyn Fischer
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Sabine Gerum
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Katrin Merkle
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Sebastian Schulz
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Anna Pallauf
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Marcus Quinkler
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Gregor Hanslik
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Katharina Lang
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Stefanie Hahner
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Bruno Allolio
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Christa Meisinger
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Rolf Holle
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Felix Beuschlein
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Martin Bidlingmaier
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Stephan Endres
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
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Rizzoni D, Agabiti-Rosei E. Structural abnormalities of small resistance arteries in essential hypertension. Intern Emerg Med 2012; 7:205-12. [PMID: 21380549 DOI: 10.1007/s11739-011-0548-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 02/17/2011] [Indexed: 11/27/2022]
Abstract
Regardless of the mechanisms that initiate the increase in blood pressure, the development of structural changes in the systemic vasculature is the end result of established hypertension. In essential hypertension, the small arteries smooth muscle cells are restructured around a smaller lumen, and there is no net growth of the vascular wall, while in some secondary forms of hypertension, a hypertrophic remodeling may be detected. Also, in non-insulin-dependent diabetes mellitus, a hypertrophic remodeling of subcutaneous small arteries is present. The results from our own group have suggested that indices of small resistance artery structure, such as the tunica media to internal lumen ratio, may have a strong prognostic significance in hypertensive patients, over and above all other known cardiovascular risk factors. Therefore, the regression of vascular alterations is an appealing goal of antihypertensive treatment. Different antihypertensive drugs seem to have different effect on vascular structure, both in human and in animal models of genetic and experimental hypertension. A complete normalization of small resistance artery structure is demonstrated in hypertensive patients, after long-term and effective therapy with ACE inhibitors, angiotensin II receptor blockers and calcium antagonists. Few data are available in diabetic hypertensive patients; however, blockade of the renin-angiotensin system seems to be effective in this regard. In conclusion, there are several pieces of evidence that suggest that small resistance artery structure may be considered an intermediate endpoint in the evaluation of the effects of antihypertensive therapy; however, there are presently no data available about the prognostic impact of the regression of vascular structural alterations in hypertension and diabetes.
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Affiliation(s)
- Damiano Rizzoni
- Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy.
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Widimsky Jr. J, Strauch B, Petrák O, Rosa J, Somloova Z, Zelinka T, Holaj R. Vascular Disturbances in Primary Aldosteronism: Clinical Evidence. ACTA ACUST UNITED AC 2012; 35:529-33. [DOI: 10.1159/000340031] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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