Dietary Salt Intake Is a Determinant of Cardiac Changes After Treatment of Primary Aldosteronism

Abstract

Primary aldosteronism is associated with increased left ventricular (LV) mass independently of blood pressure. Previous studies suggest that elevated aldosterone causes cardiac damage only in the presence of an inappropriate salt status. We examined the relevance of dietary salt intake on cardiac changes in patients with primary aldosteronism before and after treatment. Sixty-five patients with tumoral or idiopathic primary aldosteronism were recruited at a University medical center and followed after either surgical (n=30) or medical (n=35) treatment. At baseline and 1 year after treatment, cardiac morphology and functional variables were measured by echocardiography together with duplicate 24-hour urinary sodium collections. At baseline, LV mass index was associated with urinary sodium excretion and plasma aldosterone levels. During follow-up, blood pressure (from 167/102–135/83 mm Hg; P <0.001) and LV mass index (from 50.5±13.0–44.4±8.9 g/m 2.7 ; P <0.001) decreased significantly with nonsignificant changes in LV geometry and functional properties. At the end of follow-up, percentage decrease in LV mass index was significantly greater in patients who had >10% reduction in urinary sodium excretion (15.0±12.5%) than in the remaining patients (5.5±9.3%; P <0.001). Changes in LV mass index induced by both surgical and medical treatment were directly and independently correlated with changes in blood pressure (β=0.419; P =0.009) and urinary sodium excretion (β=0.334; P =0.012) observed at follow-up. These findings strongly support the hypothesis that dietary salt intake has a crucial role in aldosterone-related LV changes and could contribute to cardiac damage in patients with primary aldosteronism.

Cardiac magnetic resonance imaging of myocardial mass and fibrosis in primary aldosteronism

“…Similarly, in humans, extraordinarily high aldosterone concentrations in populations with chronic sodium deficiency was not associated with cardiovascular damage ( 49 ). A recent study demonstrated that dietary salt intake influenced the reduction of LV mass after PA treatment ( 50 ). Thus, dietary sodium intake may have influenced our results.…”

The relationship among cardiac structure, dietary salt and aldosterone in patients with primary aldosteronism

“…Therefore, their data depicted the relationship between the sodium level among PA patients with higher sodium intake (corresponding to the medium and high tertiles in our data) and LV structure. One recent study investigated the association between dietary salt intake and cardiac change after treatment in patients with PA [ 31 ]. The mean urinary sodium level of patients with PA in that study (149 mmol/d) is closer to ours.…”

Salt, Aldosterone, and Parathyroid Hormone: What Is the Relevance for Organ Damage?

“…In 21 patients with primary aldosteronism, Pimenta et al found that urinary sodium independently predicts left ventricular mass [ 54 ]. More recently, we have shown that an increased left ventricular mass is associated with daily urinary sodium excretion and plasma aldosterone levels in 65 patients with primary aldosteronism [ 55 ]. Also, and most important, we found that the extent of a reduction in left ventricular mass obtained after either surgical or medical treatment of primary aldosteronism was independently correlated with the decrease in urinary sodium observed during treatment.…”