Changes in Left Ventricular Anatomy and Function in Hypertension and Primary Aldosteronism

Abstract

We investigated the effects on the heart of hypertension due to the excess of aldosterone and suppression of the renin-angiotensin system caused by primary aldosteronism with M-mode echocardiography and transmitral Doppler flow velocity measurements. We studied 34 consecutive patients with primary aldosteronism and 34 with essential hypertension individually matched for age, gender, race, body mass index, blood pressure values, and duration of hypertension. The groups were similar in age, body mass index, blood pressure, and duration of hypertension. However, lower serum potassium levels (3.5 +/- 0.6 versus 4.1 +/- 0.2 mmol/L, P < .0001) and plasma renin activity (0.53 +/- 0.45 versus 1.82 +/- 1.59 ng Ang I x mL-1 x h-1, P < .0001) and higher plasma aldosterone levels (1107 +/- 774 versus 206 +/- 99 pmol/L, P < .0001), left ventricular wall thickness, and left ventricular mass index (112 +/- 4.7 versus 98 +/- 3.7 g/m2, P = .029) were found in patients with primary aldosteronism compared with those with essential hypertension. Similarly, the PQ interval was longer (173 +/- 20 versus 141 +/- 14 milliseconds, P < .001) in primary aldosteronism than in essential hypertension patients. Significantly more primary aldosteronism than essential hypertension patients had left ventricular hypertrophy or left ventricular concentric remodeling (50% versus 15%, chi 2 = 11.97, P = .007). Both the E wave flow velocity integral (1063 +/- 65 versus 1323 +/- 78, P = .013) and the E/A integral ratio (0.91 +/- 0.05 versus 1.25 +/- 0.08, P < .001) were lower, and atrial contribution to left ventricular filling was higher (53.3 +/- 1.5% versus 45.5 +/- 1.3% P < .001) in patients with primary aldosteronism compared with essential hypertension patients. After 1 year of follow-up, highly significant decreases of left ventricular wall thickness and mass were observed in patients treated with surgical excision of an aldosterone-producing tumor, but not in those with medical therapy. Thus, in patients with primary aldosteronism, the excess aldosterone with suppression of the renin-angiotensin system is associated with both increased left ventricular mass and significant changes of left ventricular diastolic filling. The former changes appear to be reversible on removal of the cause of excessive aldosterone production.

The prevalence of metabolic syndrome and its components in two main types of primary aldosteronism

“…6 The excess of aldosterone might be associated with remodeling of the left ventricle and higher albumin excretion. 7,8 Indeed, as we have shown recently, patients with PA have an increased intima-media thickness of the carotid artery and higher aortic stiffness compared with EH. 9,10 Aldosterone concentrations are elevated in obese and MS patients, 11 there is an increasing body of evidence linking elevated plasma aldosterone levels to MS and its components.…”

Altered sodium perception in essential hypertensive patients following rapid volume expansion

“…Also, for a given level of sodium intake and plasma Ang II level, hypertensive patients with intact modulation may carry slightly higher aldosterone levels and have the potential to retain more sodium when consuming a high salt diet. Coupled with the proposed extra-renal effects of aldosterone in promoting cardiac interstitial fibrosis 18 and left ventricular hypertrophy 19 the higher aldosterone levels may have other pathophysiologic consequences.…”

Opposite associations of circulating aldosterone and atrial natriuretic peptide with left ventricular diastolic function in essential hypertension

“…Such issues are of paramount importance for human hypertensive heart disease, but are difficult to resolve in man, because long-term administration of components of the renin-angiotensin-aldosterone-system and of atrial natriuretic peptide cannot be performed on ethical grounds. Therefore researchers have looked for associations between cardiac structure and function, and plasma renin activity, [13][14][15][16][17][18][19][20][21] angiotensin II, 15,17,20,22 aldosterone 15,[17][18][19][20]22,23 and atrial natriuretic peptide. 22,[24][25][26][27] Another approach has been to study the cardiac effects of chronic treatment with drugs which interfere with components of the reninangiotensin-system.…”

“…31 Few studies have addressed the relationships of plasma atrial natriuretic peptide with left ventricular characteristics, 22,[24][25][26][27] whereas the data on the renin-angiotensin-system, both from the correlation approach and from intervention studies are conflicting. [13][14][15][16][17][18][19][20][21][22][23]28,29 In addition, most reports emphasized cardiac structure, whereas relationships of humoral variables with diastolic function have only been studied for atrial natriuretic peptide and not for the components of the reninangiotensin-system. The purpose of the present study was therefore to assess relationships of echocardiographic left ventricular structural and functional characteristics with plasma renin activity, angiotensin II, aldosterone and atrial natriuretic peptide in patients with essential hypertension, studied in well-standardized conditions.…”