Metabolic syndrome (MS) is frequent clinical condition in patients with hypertension. Primary aldosteronism (PA) is a common form of secondary hypertension. This study was aimed at investigating the prevalence of the MS and its components in the two major forms of PA, in unilateral aldosterone-producing adenoma (APA) and bilateral aldosterone overproduction because of idiopathic hyperaldosteronism (IHA). The diagnosis of the particular form of PA was based on adrenal venous sampling and/or successful surgery confirmed by histopathological examination. We analyzed clinical and laboratory data from 100 patients with PA (50 patients with IHA and 50 patients with APA) and from 90 patients with essential hypertension (EH). Metabolic profiles of patients with bilateral form of PA (because of IHA) were similar to EH, but differed from those in patients with unilateral form of PA (APA). The prevalence of the MS (62% in IHA, 34% in APA and 56% in EH), the body mass index value (30 ± 4 kg m -2 in IHA, 27±5 kg m -2 in APA and 29±5 kg m -2 in EH) and triglycerides levels (1.9±0.9 mmol l -1 in IHA,1.4± 0.8 mmol l -1 in APA and 2.01 ± 1.39 mmol l -1 in EH) were all significantly (Po0.05) higher in IHA compared with APA patients. Metabolic profile of patients with bilateral form of PA (because of IHA) is similar to EH in contrast to unilateral form of PA (APA).

The relationship between arterial hypertension and insu lin resistance has long been established. We used primary hyperal dosteronism as a model of the relationship between secondary hy pertension and insulin sensitivity. Our group consisted of 9 patients with arterial hypertension caused by primary hyperaldosteronism. Five of these patients with aldosterone producing adenoma were operated on and four patients with idiopathic hyperaldosteronism were treated with spironolactone. Hyperinsulinaemie euglycaemic clamp technique was performed before and at least 6 months fol lowing the treatment to evaluate the insulin action. Significantly lower glucose disposal rate (M), insulin sensitivity index (M/I) and decreased metabolic clearance rale of glucose (MCR (i ) were found in patients before treatment as compared to healthy controls. In both treated groups the blood pressure and plasma potassium con centrations returned to normal values, whereas plasma aldosterone levels were normalised only after surgical removal of the adenoma. Significantly improved insulin action (M/I: 30.2 ± 5.9 vs. 51.4 ± 12.2 umol.kg" '.min 1 per mU.l" 1 X 100, p = 0.017) was observed in patients after operation of aldosterone producing adenoma. In contrast, spironolactone treatment of patients with idiopathic hyp eraldosteronism did not significantly influence insulin action (M/I: 24.5 ± 7.3 vs. 18.7 ± 7.6 umol.kg-'.rnin-' per mU.l 1 x 100, p = 0.198). Since plasma aldosterone concentrations have been normal ised only in patients after removal of the adenoma whereas they remained increased in spironolactone treated group, we suppose that aldosterone itself could play a role in the development of im paired insulin action. Downloaded by: Collections and Technical Services Department. Copyrighted material. G. Sindelka et al., Insulin action in primary hyperaldosteronism Torlone E, Rambotti AM, Perriello G, Botta G, Santeusanio F, Brunetti P, Bolli GB: ACE-inhibition increases hepatic and extrahepatic sensitivity to insulin in patients with type 2 (non-insu lin-dependent) diabetes mellitus and arterial hypertension. Diabetologia 34: 119-125, 1991 Tylor SI: Lilly lecture: Molecular mechanisms of insulin resistance. Lessons from patients with mutations in the insulin-receptor gene. Diabetes 41: 1473-1490, 1992 Widimsky J, Skrha J, Sindelka G, Hilgertova J: Is insulin resistance in primary hyperaldosteronism modifiable by treatment? J Hypert 16, Suppl SI48, 1998 Yajnik CS, Naik SS, Bhat DS, Joshi VM, Shelgikar KM, Alberti KGMM, Hockaday TDR: The relationship between obesity, 25 plasma immunoreactive insulin concentration and blood pres sure in newly diagnosed Indian type 2 diabetic patients. Diab Med 10: 146-151, 1993 Zemel MB: Insulin resistance, obesity and hypertension: an over view.

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.

The aim of our study was to explore the effects of regular aerobic exercise on anthropometric, biochemical and hormonal parameters and mRNA expression of selected factors involved in metabolic regulations in subcutaneous adipose tissue of patients with obesity. Fifteen obese women with arterial hypertension underwent a three-month exercise program consisting of 30 min of aerobic exercise 3 times a week. Fifteen healthy lean women with no intervention served as a control group. Obese group underwent anthropometric measurements, blood sampling, subcutaneous adipose tissue (SCAT) biopsy and 24-h blood pressure monitoring at baseline and after three months of exercise, while control group was examined only once. At baseline, obese group had increased SCAT expression of proinflammatory cytokines and adipokines relative to control group. Three months of regular exercise improved anthropometric parameters, decreased CRP, blood glucose and HOMA-IR, while having no significant effect on lipid profile and blood pressure. Gene expressions in SCAT were not affected by physical activity with the exception of increased aquaporin-3 mRNA expression. We conclude that three months of regular exercise decrease systemic subclinical inflammation with only minor influence on the blood pressure and the endocrine function of subcutaneous fat.

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