Myocardial and aortic stiffening in the early course of primary aldosteronism.

BACKGROUND

Primary aldosteronism (PA) has been experimentally and clinically linked to myocardial and vascular fibrosis, and it has been further associated with left ventricular (LV) structural adaptations.

HYPOTHESIS

Functional cardiovascular adaptations in hypertensive patients with PA precede structural alterations in the early stages of the disease.

METHODS

We studied 17 hypertensive subjects with a recent diagnosis of PA (10 male patients, aged approximately 55 y, with office blood pressure [BP] of 137/88 mm Hg), and 30 essential hypertensives matched for age, sex, office BP levels, treatment status, and LV mass index (LVMI). Apart from standard 2-Dimensional (2-D) and conventional Doppler parameters, tissue Doppler imaging (TDI) methodology was used to assess LV diastolic function; averaging early and late diastolic mitral annular peak velocities (Emav/, Amav, Emav/Amav ratio) from 4 separate sites of measurement (septal, lateral, anterior, and inferior walls). Aortic stiffness was evaluated by means of carotid-femoral pulse wave velocity (cf-PWV) measurements.

RESULTS

Although transmitral E/A ratio was similar in both groups (0.95+/-0.26 versus 0.98+/-0.24, p=0.66), hypertensive subjects with PA compared with essential hypertensives are characterized by significantly higher relative wall thickness (0.50+/-0.07 versus 0.41+/-0.06, p<or=0.001), decreased values of Emav (7+/-1.7 versus 8.1+/-1.8 cm/s, p=0.048), and Emav/Amav ratio (0.63+/-0.16 versus 0.77+/-0.17, p=0.015). The higher PWV in the PA population failed to reach statistical significance (8.5+/-1.6 versus 7.9+/-0.9 msec, p=0.19).

CONCLUSION

Our study demonstrates altered LV geometry and TDI-revealed diastolic dysfunction in hypertensives with PA compared with demographically- and LVMI-matched essential hypertensives. Furthermore, the increased aortic stiffening in PA patients failed to reach statistical significance.