Peripheral Arterial Stiffness in Primary Aldosteronism

Abstract

Aldosterone overproduction increases arterial wall stiffness by accumulation of different types of collagen fibres and growth factors. Our previous studies showed that central (aortic) arterial stiffness is increased in primary aldosteronism (PA) independently of concomitant hypertension and that these changes might be reversible after successful adrenalectomy. There is limited data available on the potential impact of mineralocorticoid overproduction on the deterioration of peripheral arterial stiffness. The current study was thus aimed at investigating the effect of aldosterone overproduction on peripheral arterial stiffness assessed by peripheral (femoral-ankle) pulse wave velocity (PWV) in PA patients compared with essential hypertension (EH) patients. Forty-nine patients with confirmed PA and 49 patients with EH were matched for age, blood pressure, body mass index, lipid profile, and fasting glucose. PWV was obtained using the Sphygmocor applanation tonometer. Both peripheral and central PWV were significantly higher in PA patients compared to EH patients, while clinical blood pressures were similar. Plasma aldosterone level was the main predictor of peripheral PWV in PA. Our data indicate aldosterone overproduction in PA does not preferentially affect central arterial system. Fibroproliferative effect of higher aldosterone levels lead to alteration of central-elastic as well as peripheral-muscular arteries with subsequent increase in its stiffness.

Time course and factors predicting arterial stiffness reversal in patients with aldosterone-producing adenoma after adrenalectomy: prospective study of 102 patients

“…baPWV evaluated muscular peripheral arteries and haPWV evaluated the combination of muscular peripheral arteries and elastic central arteries. In a previous study, PA pateints had both higher central and peripheral PWV than EH patients 28 . In the presented study, we found both baPWV and haPWV got improvement after adrenalectomy.…”

“…PA patients have increases in both central-elastic and peripheral-muscular arterial stiffness 28 . Besides, PA patients have a thicker carotid intima-media layer, which may be due to carotid wall fibrosis 13 , and this can also be reversed after adrenalectomy in APA patients 15 .…”

Cardiovascular Risk in Primary Hyperaldosteronism

“…Pulse wave velocity (PWV) is regarded to be a reliable marker of arterial stiffness. Several studies showed increased PWV values as compared to EH patients and this difference was independent from BP levels on office and ABPM [53,54]. It is of interest that, in contrast to surgical treatment, medical treatment with spironolactone had no effect on aortic stiffness indices, including PWV.…”

Long‐term BP control and vascular health in patients with hyperaldosteronism treated with low‐dose, amiloride‐based therapy

“…Nongenetic forms of HA are often treated surgically but chronic oral mineralocorticoid receptor (MR) antagonism, generally with spironolactone, has also been used to lower BP . It is believed that the end‐organ damage profile in patients with HA is more severe than essential hypertension, including increased prevalence of cerebral hemorrhage, myocardial infarction, left ventricular hypertrophy, cardiac fibrosis, increased arterial stiffness, microalbuminuria, and microcirculatory wall‐to‐lumen ratio . Attribution of HA‐associated target organ damage, however, is universally confounded by the effects of aging as well as the duration and degree of BP elevation (BP burden) .…”