Cerebro-Cardiovascular Risk, Target Organ Damage, and Treatment Outcomes in Primary Aldosteronism

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.

Differences in Glycemic Abnormalities Between Primary Aldosteronism and Essential Hypertension: A Systematic Review and Meta-Analysis

“…An enhanced risk of atherosclerotic cardiovascular and cerebrovascular diseases in PA patients has been reported ( 7 , 8 , 49 ). A theory has been proposed that in PA, excess aldosterone can lead to arterial wall thickening and fibrosis, and that increased oxidative stress and inflammation can result in endothelial dysfunction ( 50 ).…”

“…Apart from the effect of sodium retention and electrolyte dysregulations, studies have demonstrated that PA is also related to endothelial dysfunction, fibrosis, increased oxidative stress and increased risk of cardiac fibrosis ( 5 , 6 ). These adverse mechanisms may explain the significantly increased risk of cardiovascular and cerebrovascular diseases in PA compared to essential hypertension (EH) patients ( 7 , 8 ).…”

Atrial Fibrillation and Primary Aldosteronism: A Meta-Analysis

“…Long-term exposure to elevated aldosterone levels might result in substantial cardiovascular damage independent of blood pressure [2]. It has been associated with cardiovascular damage and with marked target organ damage affecting the heart, the carotid artery, or the kidney [4][5].…”

The causal association between primary aldosteronism and cardiovascular diseases: a bidirectional two-sample Mendelian randomization study

“…These data suggested that the causal relationship between PA and the risk of CVDs remains controversial. In addition, studies have shown that acute myocardial infarction was associated with high aldosterone secretion exacerbating myocardial damage [15,16] and further leading to the occurrence of adverse events (OR = 1.1, 95%CI: 1.03-1.15) [17], and PA showed prevalent among hypertensive patients with unexplained atrial brillation, up to 42% (95%CI: 31.8-53.9)[18], highlighting the bidirectional association between PA and CVDs.…”