Catena Cristiana, Colussi GianLuca, Lapenna Roberta, Nadalini Elisa, Chiuch Alessandra, Gianfagna Pasquale, Sechi Leonardo A
Division of Internal Medicine, Hypertension and Cardiovascular Unit, Department of Experimental and Clinical Pathology and Medicine, University of Udine, Udine, Italy.
Hypertension. 2007 Nov;50(5):911-8. doi: 10.1161/HYPERTENSIONAHA.107.095448. Epub 2007 Sep 24.
Exposure to excess aldosterone results in cardiac damage in hypertensive states. We evaluated the long-term cardiac structural and functional evolution in patients with primary aldosteronism after surgical or medical treatment. Fifty-four patients with primary aldosteronism were enrolled in a prospective study and were followed for a mean of 6.4 years after treatment with adrenalectomy (n=24) or spironolactone (n=30). At baseline, echocardiographic measurements of patients with primary aldosteronism were compared with those of 274 patients with essential hypertension. Patients with primary aldosteronism had greater left ventricular mass, more prevalent left ventricular hypertrophy, lower early:late-wave diastolic filling velocities ratio, and longer deceleration time than patients with essential hypertension but no differences in relative wall thickness and systolic function. During follow-up, average blood pressure was 135/82 and 137/82 mm Hg in patients treated with adrenalectomy and spironolactone, respectively. In the initial 1-year period, left ventricular mass decreased significantly only in adrenalectomized patients. Subsequent changes in left ventricular mass were greater in patients treated with spironolactone, with an overall change from baseline to the end of follow-up that was comparable in the 2 groups. Prevalence of hypertrophy decreased in both treatment groups, whereas diastolic parameters had only mild and nonsignificant improvement. Changes in blood pressure and pretreatment plasma aldosterone were independent predictors of left ventricular mass decrease in both treatment groups. Thus, in the long-term, both adrenalectomy and spironolactone are effective in reducing left ventricular mass in patients with primary aldosteronism, with effects that are partially independent of blood pressure changes.
暴露于过量醛固酮会导致高血压状态下的心脏损伤。我们评估了原发性醛固酮增多症患者在手术或药物治疗后的长期心脏结构和功能演变。54例原发性醛固酮增多症患者纳入一项前瞻性研究，在接受肾上腺切除术（n = 24）或螺内酯治疗（n = 30）后平均随访6.4年。基线时，将原发性醛固酮增多症患者的超声心动图测量结果与274例原发性高血压患者的结果进行比较。原发性醛固酮增多症患者的左心室质量更大，左心室肥厚更普遍，舒张早期与晚期充盈速度比值更低，减速时间更长，与原发性高血压患者相比，但相对室壁厚度和收缩功能无差异。随访期间，接受肾上腺切除术和螺内酯治疗的患者平均血压分别为135/82和137/82 mmHg。在最初的1年期间，仅肾上腺切除患者的左心室质量显著下降。随后，螺内酯治疗患者的左心室质量变化更大，两组从基线到随访结束的总体变化相当。两个治疗组的肥厚患病率均下降，而舒张参数仅有轻微且无显著改善。血压变化和治疗前血浆醛固酮是两个治疗组左心室质量下降的独立预测因素。因此，长期来看，肾上腺切除术和螺内酯在降低原发性醛固酮增多症患者的左心室质量方面均有效，其效果部分独立于血压变化。
