Ventricular repolarization before and after treatment in patients with secondary hypertension due to renal-artery stenosis and primary aldosteronism

Maule, Simona; Bertello, Chiara; Rabbia, Franco; Milan, Alberto; Mulatero, Paolo; Milazzo, Valeria; Papotti, G; Veglio, Franco

doi:10.1038/hr.2011.77

Cited by 4 publications

(5 citation statements)

References 33 publications

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“…It is now well established that, compared to patients with essential hypertension, QTc interval is prolonged in patients with hyperaldosteronism (primary aldosteronism or Conn's adenoma), with a high proportion of patients experiencing QTc values higher than 440 ms (Matsumura, K., et al, 2005;Maule, S., et al, 2011). Several explanations may be proposed.…”

Section: Impact Of Aldosterone a Non-sex Steroid Hormone On Cardiacmentioning

confidence: 99%

“…Several explanations may be proposed. First, the presence of higher blood pressure levels, due to the increased aldosterone secretion, might contribute to QT interval prolongation in these patients (Maule, S., et al, 2011). Indeed, hyperaldosteronism is associated with high blood pressure levels and left ventricular hypertrophy (Milliez, P., et al, 2005) and patients with left ventricular hypertrophy exhibit prolonged QT interval (Dritsas, A., et al, 1992;Martin, A.B., et al, 1994) possibly as a consequence of down-regulation of the human ether-a-go-go related gene expression (Hu, C., et al, 2011).…”

Section: Impact Of Aldosterone a Non-sex Steroid Hormone On Cardiacmentioning

confidence: 99%

“…These observations have been confirmed by pharmacological manipulations using mineralocorticoid receptor antagonists. Spironolactone, a nonselective mineralocorticoid receptor antagonist, in contrast with its blocking properties on human IKr (Caballero, R., et al, 2003), shortened QTc in primary aldosteronism (from 423 ± 23 ms to 403 ± 12ms; P<0.01) (Maule, S., et al, 2011) and in coronary artery disease patients without heart failure (from 440 ± 28 ms to 425 ± 25 ms; P<0.001) (Shah, N.C., et al, 2007). Spironolactone also reduced QTc dispersion and shortened QTc in patients with systolic heart failure (Yee, K.M., et al, 2001).…”

Section: Impact Of Aldosterone a Non-sex Steroid Hormone On Cardiacmentioning

confidence: 99%

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Influence of steroid hormones on ventricular repolarization

Salem

Alexandre

Bachelot

et al. 2016

Pharmacology & Therapeutics

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QT interval prolongation, corrected for heart rate (QTc), either spontaneous or drug-induced, is associated with an increased risk of torsades de pointes and sudden death. Women have longer QTc than men and are at higher risk of torsades de pointes, particularly during post-partum and the follicular phase. Men with peripheral hypogonadism have longer QTc than healthy controls. The role of the main sex steroid hormones has been extensively studied with inconsistent findings. Overall, estradiol is considered to promote QTc lengthening while progesterone and testosterone shorten QTc. New findings suggest more complex regulation of QTc by sex steroid hormones involving gonadotropins (i.e. follicle-stimulating hormone), the relative concentrations of sex steroid hormones (which depends on gender, i.e., progesterone/estradiol ratio in women). Aldosterone, another structurally related steroid hormone, can also prolong ventricular repolarization in both sex. Better understanding of pathophysiological hormonal processes which may lead to increased susceptibility of women (and possibly hypogonadic men) to drug-induced arrhythmia may foster preventive treatments (e.g. progesterone in women). Exogenous hormonal intake might offer new therapeutic opportunities or, alternatively, increase the risk of torsades de pointes. Some exogenous sex steroids may also have paradoxical effects on ventricular repolarization. Lastly, variations of QTc in women linked to the menstrual cycle and sex hormone fluctuations are generally ignored in regulatory thorough QT studies. Investigators and regulatory agencies promoting inclusion of women in thorough QT studies should be aware of this source of variability especially when studying drugs over several days of administration.

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Section: Impact Of Aldosterone a Non-sex Steroid Hormone On Cardiacmentioning

confidence: 99%

Section: Impact Of Aldosterone a Non-sex Steroid Hormone On Cardiacmentioning

confidence: 99%

Section: Impact Of Aldosterone a Non-sex Steroid Hormone On Cardiacmentioning

confidence: 99%

See 1 more Smart Citation

Influence of steroid hormones on ventricular repolarization

Salem

Alexandre

Bachelot

et al. 2016

Pharmacology & Therapeutics

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“…It has been shown that PA patients display an increased prevalence of long QT, at least in part independent from potassium levels [ 60 ] , which is reverted after adrenalectomy or therapy with spironolactone [ 61 ] .…”

Section: Clinical Features and Complications Of Pamentioning

confidence: 99%

Primary Aldosteronism: Progress in Diagnosis, Therapy, and Genetics

Mulatero

Williams

Monticone

et al. 2012

Endocrine Hypertension

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Primary aldosteronism (PA) is the most frequent cause of secondary hypertension and its prevalence increases with the severity of hypertension. The importance of PA diagnosis is not just related to offering a targeted treatment, that is, adrenalectomy, for aldosterone-producing adenoma and medical therapy with mineralocorticoid receptor antagonists for bilateral adrenal hyperplasia, but also because it has been demonstrated extensively that patients affected by PA are more susceptible to cardiovascular events and target organ damage compared to essential hypertensives. Herein, we review the pathophysiology of PA and its clinical features and potential complications; the three step approach employed in the diagnosis of PA, established by the Endocrine Society Guidelines, that is, screening, con fi rmation/exclusion, and subtype diagnosis are discussed; the rarer, familial, and sporadic genetic forms of PA are explained and we conclude with a section on targeted PA therapy.

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“…Of that group, 16 were revascularized and tolerated re-introduction of these agents without difficulty (14). A separate report indicated that patients with RVH had prolonged QT intervals during medical therapy as compared to essential hypertension (17). Twenty-four of these underwent renal artery stenting with normalization of the QT interval.…”

Section: Medical Therapy Of Hypertension With Renovascular Diseasementioning

confidence: 99%

Renovascular hypertension

Textor¹

2013

Current Opinion in Nephrology and Hypertension

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Purpose Management of renovascular hypertension remains controversial and problematic, in part due to failure of prospective trials to demonstrate added benefit to revascularization. Recent Findings Effective drug therapy often can achieve satisfactory blood pressure control, although concerns persist for the potential for progressive, delayed loss of kidney function beyond a stenotic lesion. Recent studies highlight benefits of renal artery stenting in subsets of patients including those with recurrent pulmonary edema and those intolerant to blockade of the renin-angiotensin system. Occasional patients with recent deterioration in renal function recover sufficient GFR after stenting to avoid requirements for renal replacement therapy. Emerging paradigms from both clinical and experimental studies suggest that hypoxic injury within the kidney activates inflammatory injury pathways and microvascular rarification that may not recover after technically successful revascularization alone. Initial data suggest that additional measures to repair the kidney, including the use of cell-based therapy, may offer the potential to recover kidney function in advanced renovascular disease. Summary Specific patient groups benefit from renal revascularization. Nephrologists will increasingly be asked to manage complex renovascular patients different from those in randomized trials that require intensely individualized management.

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Ventricular repolarization before and after treatment in patients with secondary hypertension due to renal-artery stenosis and primary aldosteronism

Cited by 4 publications

References 33 publications

Influence of steroid hormones on ventricular repolarization

Influence of steroid hormones on ventricular repolarization

Primary Aldosteronism: Progress in Diagnosis, Therapy, and Genetics

Renovascular hypertension

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