Essential hypertension: First reason for persistent hypertension after unilateral adrenalectomy for primary aldosteronism?

Proye, C; Mulliez, E.; Carnaille, B.; Lecomte-Houcke, M; Decoulx, M; Wémeau, J. L.; Lefèbvre, J; Racadot, A; Ernst, Olivier; Huglo, D.; Carré, A

doi:10.1067/msy.1998.93108

Cited by 109 publications

(86 citation statements)

References 16 publications

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“…In our prospective study, 39% of patients with primary aldosteronism had their BP normalized by treatment, with the remaining 61% requiring persistent use of one or more antihypertensive agents. Retrospective studies identified younger age, shorter duration of disease, and milder antihypertensive therapy as factors that were associated with resolution of hypertension after correction of primary aldosteronism (34,(41)(42)(43)(44). Our patients with measurable plasma renin had higher baseline BP than patients with suppressed renin and reached comparable BP levels during follow-up but at the Figure 3.…”

Section: Discussionmentioning

confidence: 84%

Relationships of Plasma Renin Levels with Renal Function in Patients with Primary Aldosteronism

Catena¹,

Colussi²,

Nadalini³

et al. 2007

Clinical Journal of the American Society of Nephrology

102

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Background: The renal damage that is present in primary aldosteronism might reflect functional and potentially reversible abnormalities that are initiated by glomerular hyperfiltration. The aim of this study was to investigate the relationships of plasma renin and aldosterone concentrations with renal outcomes after treatment of primary aldosteronism.Design, setting, participants, and measurements: Fifty-six consecutive patients who had primary aldosteronism and were recruited in a university center were studied. Patients were prospectively followed after either surgical or medical treatment for a mean of 6.2 yr, during which they received antihypertensive drugs to reach a target BP of <140/90 mmHg.Results: At baseline, patients with primary aldosteronism had higher creatinine clearance and albuminuria than 323 patients with essential hypertension and 113 normotensive individuals. In patients with primary aldosteronism, plasma active renin levels that were higher than the lower limit of detection (2.5 pg/ml) were associated with higher BP, plasma potassium, and albuminuria and lower creatinine clearance. Plasma aldosterone concentrations that were higher than the median value (225 pg/ml) were associated with lower plasma potassium and higher creatinine clearance. Creatinine clearance was correlated directly with plasma aldosterone and inversely with renin. During follow-up, patients with higher baseline plasma renin required use of more antihypertensive drugs to obtain BP control and had a smaller early decline in albuminuria than did patients with suppressed renin.Conclusions: Escape of renin from suppression by excess aldosterone is associated with evidence of more severe renal damage in patients with primary aldosteronism and predicts less favorable outcomes after treatment.

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Section: Discussionmentioning

confidence: 84%

Relationships of Plasma Renin Levels with Renal Function in Patients with Primary Aldosteronism

Catena¹,

Colussi²,

Nadalini³

et al. 2007

Clinical Journal of the American Society of Nephrology

102

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“…These findings above indicate that an expression of MDM2 is strongly induced by aldosterone itself via MR in VSMCs both in vitro and in vivo, and MDM2 may be possibly involved in aldosterone-induced vascular structural remodeling of human resistance arteries, which may result in persistent hypertension even after resection of aldosterone-producing adrenocortical adenoma. 22 VSMCs used in this study were also associated with 11␤-HSD type 2 expression. It is known that both aldosterone and cortisol bind to human MR with equal affinity.…”

Section: Discussionmentioning

confidence: 97%

MDM2: A Novel Mineralocorticoid-Responsive Gene Involved in Aldosterone-Induced Human Vascular Structural Remodeling

Nakamura

Suzuki

et al. 2006

The American Journal of Pathology

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Aldosterone has been demonstrated to play an important role in the pathogenesis of various cardiovascular diseases. Vascular structural remodeling, including vascular smooth muscle cell (VSMC) proliferation, has been also reported in small resistance arteries of patients with primary aldosteronism. Therefore, in this study, we examined whether genes involved in the regulation of the cell cycle were induced by aldosterone alone in cultured human VSMCs and in human small resistance arteries. Results of these studies eventually demonstrated that MDM2, one of the genes involved in anti-apoptosis and cell growth, was markedly increased in mineralocorticoid receptor ( Aldosterone is a steroid hormone synthesized in the zona glomerulosa of human adrenal cortex as a result of stimulation by angiotensin II and others.

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“…In fact, despite many efforts over the years, only age and lack of family history of HT were suggested to significantly predict the BP response. [5][6][7][8] Nevertheless, the large uncertainties in the prediction estimates render them of little, if any, 8 value on an individual basis.…”

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confidence: 99%

Vascular Remodeling and Duration of Hypertension Predict Outcome of Adrenalectomy in Primary Aldosteronism Patients

et al. 2008

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Abstract-Remodeling of the resistance arteries is a hallmark of arterial hypertension and predicts cardiovascular events, but it was unknown whether it could also predict the blood pressure response to adrenalectomy of patients with an aldosterone-producing adenoma. Therefore, we investigated the outcome of adrenalectomy as a function of vascular remodeling in the context of the preoperative features of aldosterone-producing adenoma patients. At 2 referral centers for hypertension, we prospectively measured the media:lumen ratio of small arteries from fat tissue of 50 consecutive aldosterone-producing adenoma patients treated with adrenalectomy. The blood pressure response to adrenalectomy was assessed by considering the blood pressure values and the number and dosages of antihypertensive medications. Adrenalectomy significantly (PϽ0.001) lowered plasma aldosterone (from 27.3Ϯ4.9 ng/dL to 8.3Ϯ11.2 ng/dL), the aldosterone:renin ratio (from 117Ϯ35 to 11Ϯ2), and blood pressure (from 163Ϯ22/98Ϯ2 mm Hg to 133Ϯ2/ 84Ϯ1 mm Hg), even despite a reduction (from 141Ϯ14 to 100Ϯ15; Pϭ0.02) of the score of antihypertensive treatment.It provided cure of hypertension in 30% of the aldosterone-producing adenoma patients, normotension with less antihypertensive therapy in 52%, and improved blood pressure control in the rest. The media:lumen ratio and the known duration of hypertension significantly predicted the blood pressure response to adrenalectomy at univariate and multivariate analyses. Because a long duration of hypertension and/or the presence of vascular remodeling imply lower chances of blood pressure normalization at long-term follow-up postadrenalectomy, these findings emphasize the importance of an early diagnosis of aldosterone-producing adenoma. Key Words: secondary hypertension Ⅲ aldosterone Ⅲ aldosteronism Ⅲ adrenalectomy Ⅲ outcome Ⅲ vascular remodeling P rimary aldosteronism (PA) is far more common than usually perceived and is attributable to an aldosteroneproducing adenoma (APA) in approximately half of the patients. 1 Thus, it entails the most common endocrine form of secondary arterial hypertension (HT) that is curable by adrenalectomy in many patients. 2 Identification of an APA, or unilateral primary adrenocortical hyperplasia, 3 requires adrenal vein sampling (AVS) that, being minimally risky, should be reserved for patients who are candidates for adrenalectomy and, more importantly, can benefit from it. 4 However, the identification of patients who will benefit more remains a challenging task, because the blood pressure (BP) response to adrenalectomy varies widely across patients. In fact, despite many efforts over the years, only age and lack of family history of HT were suggested to significantly predict the BP response. 5-8 Nevertheless, the large uncertainties in the prediction estimates render them of little, if any, 8 value on an individual basis.The remodeling of resistance arteries is a hallmark of arterial HT and can be implicated in the excess cardiovascular damage associated with HT. Hence, it ...

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Essential hypertension: First reason for persistent hypertension after unilateral adrenalectomy for primary aldosteronism?

Cited by 109 publications

References 16 publications

Relationships of Plasma Renin Levels with Renal Function in Patients with Primary Aldosteronism

Relationships of Plasma Renin Levels with Renal Function in Patients with Primary Aldosteronism

MDM2: A Novel Mineralocorticoid-Responsive Gene Involved in Aldosterone-Induced Human Vascular Structural Remodeling

Vascular Remodeling and Duration of Hypertension Predict Outcome of Adrenalectomy in Primary Aldosteronism Patients

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