原发性醛固酮增多症患者的动脉僵硬度、内膜中层厚度和颈动脉纤维化

Arterial stiffness, intima-media thickness and carotid artery fibrosis in patients with primary aldosteronism.

作者信息

Bernini Giampaolo, Galetta Fabio, Franzoni Ferdinando, Bardini Michele, Taurino Chiara, Bernardini Melania, Ghiadoni Lorenzo, Bernini Matteo, Santoro Gino, Salvetti Antonio

机构信息

Department of Internal Medicine, University of Pisa, Pisa, Italy.

出版信息

J Hypertens. 2008 Dec;26(12):2399-405. doi: 10.1097/HJH.0b013e32831286fd.

DOI:10.1097/HJH.0b013e32831286fd

PMID:19008719

Abstract

OBJECTIVES

To evaluate vascular wall structure and conduit artery stiffness in patients with primary aldosteronism.

METHODS

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.

RESULTS

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).

CONCLUSION

Aldosterone excess is responsible per se for vascular morphological (wall thickening and carotid artery fibrosis) and functional (central stiffness) damage.

摘要

目的

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。

方法

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。

结果

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）。