Comparison of Changes in Cardiac Structure After Treatment in Secondary Hypertension

Abstract

To investigate the role of aldosterone and the renin-angiotensin system in cardiac structure, we performed echocardiography in patients with secondary hypertension. The relation between blood pressure or hormonal influences and left ventricular hypertrophy has not been well established in secondary hypertension. Sixteen patients with primary aldosteronism and 11 with unilateral renovascular hypertension who had completely normalized blood pressure after operation or percutaneous transluminal angioplasty were evaluated by echocardiography before and after surgery or other interventional treatment. Blood pressure was not statistically different between the groups before treatment and was normalized after treatment in both groups. Left ventricular hypertrophy was mild in both groups before treatment, and its degree was not statistically different between the groups. At the end of the follow-up period, all parameters of primary aldosteronism and left ventricular mass index in patients with unilateral renovascular hypertension were significantly reduced. In patients with primary aldosteronism, changes in end-diastolic left ventricular internal dimension correlated positively with changes in left ventricular mass index (r=.58,P<.01). In patients with unilateral renovascular hypertension, changes in mean blood pressure and left ventricular mass index were significantly correlated (r=.77,P<.01). The expanded plasma volume induced by an excess of aldosterone and high blood pressure may play an important role in the increase of left ventricular mass in primary aldosteronism. In unilateral renovascular hypertension, high blood pressure mainly contributes significantly to increased left ventricular mass. Therefore, different factors may modulate the development of left ventricular hypertrophy in patients with secondary hypertension.

Long-Term Control of Arterial Hypertension and Regression of Left Ventricular Hypertrophy With Treatment of Primary Aldosteronism

“…[2][3][4]9,[19][20][21][22][23][24][25][26][27][28] Cardiac fibrosis with ensuing altered LV diastolic dysfunction can lead to left atrium dilatation and increased risk of atrial fibrillation (AF) 7,8,29 ; whether these changes regress with specific treatment for PA remains uncertain. 3,4,19,20,26 We, therefore, set out to prospectively investigate the long-term effects of correction of hyperaldosteronism on BP, LV mass, and cardiovascular events in a large cohort of patients with PA.Abstract-Primary aldosteronism (PA), a common cause of high blood pressure (BP), induces left ventricular (LV) hypertrophy and an excess rate of cardiovascular events. Whether its treatment provides long-term cure of hypertension and regression of cardiovascular damage remains uncertain.…”

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

“…Various populations have been studied, ie, young healthy adults, 20 employed subjects 16 or middle-aged men in a general population, 15 children and adolescents 18 or adults with essential hypertension, 13,14,17,19,22 and patients with renovascular hypertension. 21 Most authors did not observe a significant relationship of left ventricular mass (index) or wall thickness, or both, with plasma renin activity. [13][14][15]17,18,21 Left ventricular mass (index) correlated significantly though weakly (0.30 Ͻ r Ͻ 0.35) with plasma renin activity in one report in young healthy adults 20 and another in hypertensives 19 but independence of possible confounding factors was not assessed.…”

“…21 Most authors did not observe a significant relationship of left ventricular mass (index) or wall thickness, or both, with plasma renin activity. [13][14][15]17,18,21 Left ventricular mass (index) correlated significantly though weakly (0.30 Ͻ r Ͻ 0.35) with plasma renin activity in one report in young healthy adults 20 and another in hypertensives 19 but independence of possible confounding factors was not assessed. By contrast, stepwise multiple logistic regression revealed that left ventricular hypertrophy was even associated with low renin levels in patients with sustained 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.…”