Bernini Giampaolo, Galetta Fabio, Franzoni Ferdinando, Bardini Michele, Taurino Chiara, Bernardini Melania, Ghiadoni Lorenzo, Bernini Matteo, Santoro Gino, Salvetti Antonio
Department of Internal Medicine, University of Pisa, Pisa, Italy.
J Hypertens. 2008 Dec;26(12):2399-405. doi: 10.1097/HJH.0b013e32831286fd.
To evaluate vascular wall structure and conduit artery stiffness in patients with primary aldosteronism.
This observational study, conducted in a University Hypertension Center, evaluated the carotid wall by 2-D ultrasonography and ultrasonic tissue characterization, and analyzed arterial stiffness by applanation tonometer. Twenty-three consecutive patients with primary aldosteronism, 24 matched patients with essential hypertension and 15 controls were studied. Intima-media thickness and corrected integrated backscatter signal of the carotid arteries were evaluated. Radial and femoral pulse wave velocity and aortic augmentation index were also investigated.
Intima-media thickness in patients with essential hypertension (0.69 +/- 0.03 mm) was higher (P < 0.04) than that in controls (0.59 +/- 0.02 mm). This finding was more evident in primary aldosteronism patients (0.84 +/- 0.03 mm), in whom intima-media thickness was greater than that in controls (P < 0.0001) or in patients with essential hypertension (P < 0.01). Similarly, corrected integrated backscatter signal in patients with essential hypertension (-23.6 +/- 0.35 dB) was higher (P < 0.0001) than that in controls (-26.2 +/- 0.44 dB), but it was even more elevated in patients with primary aldosteronism (-22.1 +/- 0.46 dB), who showed greater corrected integrated backscatter signal than was the case in patients with essential hypertension (P < 0.009) or in controls (P < 0.0001). Femoral pulse wave velocity was higher in primary aldosteronism patients (10.8 +/- 0.57 m/s) than in patients with essential hypertension (9.1 +/- 0.34 m/s, P < 0.03) or in controls (7.1 +/- 0.51 m/s, P < 0.0001). Femoral pulse wave velocity was lower in controls than in patients with essential hypertension (P < 0.0001). The same pattern was observed for radial pulse wave velocity. Aortic augmentation index was higher in primary aldosteronism patients (28.2 +/- 2.1%) than in patients with essential hypertension (26.0 +/- 1.8%) or in controls (16.8 +/- 2.0%, P < 0.001). Patients with essential hypertension likewise exhibited higher aortic augmentation index than controls (P < 0.001).
Aldosterone excess is responsible per se for vascular morphological (wall thickening and carotid artery fibrosis) and functional (central stiffness) damage.
评估原发性醛固酮增多症患者的血管壁结构和传导动脉僵硬度。
本观察性研究在一所大学高血压中心进行，通过二维超声和超声组织特征评估颈动脉壁，并使用压平式眼压计分析动脉僵硬度。对23例连续的原发性醛固酮增多症患者、24例匹配的原发性高血压患者和15例对照者进行了研究。评估了颈动脉的内膜中层厚度和校正后的积分背向散射信号。还研究了桡动脉和股动脉脉搏波速度以及主动脉增强指数。
原发性高血压患者的内膜中层厚度（0.69±0.03mm）高于对照组（0.59±0.02mm）（P<0.04）。这一发现在原发性醛固酮增多症患者（0.84±0.03mm）中更为明显，其内膜中层厚度大于对照组（P<0.0001）或原发性高血压患者（P<0.01）。同样，原发性高血压患者的校正后的积分背向散射信号（-23.6±0.35dB）高于对照组（-26.2±0.44dB）（P<0.0001），但在原发性醛固酮增多症患者中更高（-22.1±0.46dB），其校正后的积分背向散射信号高于原发性高血压患者（P<0.009）或对照组（P<0.0001）。原发性醛固酮增多症患者的股动脉脉搏波速度（10.8±0.57m/s）高于原发性高血压患者（9.1±0.34m/s，P<0.03）或对照组（7.1±0.51m/s，P<0.0001）。对照组的股动脉脉搏波速度低于原发性高血压患者（P<0.0001）。桡动脉脉搏波速度也观察到相同的模式。原发性醛固酮增多症患者的主动脉增强指数（28.2±2.1%）高于原发性高血压患者（26.0±1.8%）或对照组（16.8±2.0%，P<0.001）。原发性高血压患者的主动脉增强指数同样高于对照组（P<0.001）。
醛固酮过量本身会导致血管形态学（血管壁增厚和颈动脉纤维化）和功能性（中心僵硬度）损害。
