Background
Primary aldosteronism (PA) is a frequent cause of hypertension. Aldosterone excess together with high dietary salt intake aggravates cardiovascular damage, despite guideline‐recommended mineralocorticoid receptor antagonist (MRA) treatment.
Objectives
To investigate the antihypertensive impact of a moderate dietary salt restriction and associated physiological changes, including mental well‐being.
Methods
A total of 41 patients with PA on a stable antihypertensive regimen—including MRA—followed a dietary salt restriction for 12 weeks with structured nutritional training and consolidation by a mobile health app. Salt intake and adherence were monitored every 4 weeks using 24‐h urinary sodium excretion and nutrition protocols. Body composition was assessed by bioimpedance analysis and mental well‐being by validated questionnaires.
Results
Dietary salt intake significantly decreased from 9.1 to 5.2 g/d at the end of the study. In parallel, systolic (130 vs. 121 mm Hg) and diastolic blood pressure (BP) (84 vs. 81 mm Hg) improved significantly. Patients’ aptitude of estimating dietary salt content was refined significantly (underestimation by 2.4 vs. 1.4 g/d). Salt restriction entailed a significant weight loss of 1.4 kg, improvement in pulse pressure (46 vs. 40 mm Hg) and normalization of depressive symptoms (PHQD scale, p < 0.05). Salt restriction, cortisol after dexamethasone suppression test and dosage of renin‐angiotensin‐aldosterone‐system (RAAS) blockers were independently associated with BP reduction.
Conclusion
A moderate restriction of dietary salt intake in patients with PA substantially reduces BP and depressive symptoms. Moreover, the findings underline that a sufficient RAAS blockade seems to augment the effects of salt restriction on BP and cardiovascular risk.
Context:
Primary aldosteronism (PA) causes left ventricular hypertrophy (LVH) via hemodynamic factors and directly by aldosterone effects. Specific treatment by mineralocorticoid receptor antagonists (MRA) or adrenalectomy (ADX) has been reported to improve LVH. However, cardiovascular benefit could depend on plasma renin concentration (PRC) in patients on MRA.
Patients and Objective:
We analyzed data from 184 patients from the Munich center of the German Conn’s Registry, who underwent echocardiography at time of diagnosis and one year after treatment. To assess the effect of PRC on cardiac recovery we stratified patients on MRA according to suppression (n=46) or non-suppression of PRC (n=59) at follow-up and compared them to PA patients after ADX (n=79).
Results:
At baseline, patients treated by ADX or MRA had comparable left ventricular mass index (LVMI, 61.7 vs 58.9 g/m2.7, p= 0.591). Likewise, patients on MRA had similar LVMI at baseline, when stratified into treatment groups with suppressed and unsuppressed PRC during follow-up (60.0 vs 58.1 g/m2.7, p= 0.576). In all three groups we observed a significant reduction in LVMI following treatment (p<0.001). However, patients with suppressed PRC had no decrease in pro-BNP levels and the reduction of LVMI was less intense than in patients with unsuppressed PRC (4.1 vs 8.2 g/m2.7, p= 0.033) or after ADX (9.3 g/m2.7, p= 0.019). Similarly, in multivariate analysis, higher PRC was correlated with the regression of LVH.
Conclusion:
PA patients with suppressed PRC on MRA show impaired regression of LVH. Therefore, dosing of MRA according to PRC, could improve their cardiovascular benefit.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.