Petramala Luigi, Pignatelli Pasquale, Carnevale Roberto, Zinnamosca Laura, Marinelli Cristiano, Settevendemmie Amina, Concistrè Antonio, Tonnarini Gianfranco, De Toma Giorgio, Violi Francesco, Letizia Claudio
aInternal Medicine and Secondary Arterial Hypertension Unit bInternal Medicine Division, Department of Internal Medicine and Medical Specialties cDepartment of Surgery, 'P. Valdoni', University of Rome, 'Sapienza', Italy.
J Hypertens. 2014 Oct;32(10):2022-9; discussion 2029. doi: 10.1097/HJH.0000000000000284.
Primary aldosteronism, an important form of secondary hypertension, is associated with significant increase of cardiovascular risk (ischaemic heart, cerebrovascular events, arrhythmias) (relative risk 4.6). The specific treatment of primary aldosteronism significantly reduces cardiovascular risk. In addition to high blood pressure values and direct action of aldosterone, new mechanisms such as increased oxidative stress are involved in the development of organ damage, metabolic, endothelial and coagulation complications.
The aim of the study was to evaluate parameters of oxidative stress in 38 patients (21 men, 17 women, mean age 53.3 ± 4.7 years) with primary aldosteronism [11 aldosterone-producing adenoma (APA) (4 men, 7 women, mean age 50.2 ± 4.5 years) and 27 idiopathic adrenal hyperplasia (IHA) (17 men, 10 women, mean age 54.5 ± 5.3 years)] at diagnosis and after specific treatment (surgical or pharmacological), with respect to 50 patients with essential hypertension (26 men, 24 women, mean age 49 ± 7.4 years) and 50 healthy individuals (28 men, 22 women, mean age 48.7 ± 4.4 years).
Patients with primary aldosteronism showed significant increase of NADPH oxidase (Nox2-dp) plasma levels and urinary isoprostanes (34.9 ± 4.3 μg/dl and 216.3 ± 15.7 ng/mg, respectively; P < 0.05) than essential hypertensive patients (27.1 ± 3.7 μg/dl and 144.8 ± 9.4 ng/mg, respectively; P < 0.05). In APA patients undergoing adrenalectomy, we observed significant reduction of both circulating levels of Nox2-dp (29 ± 2.1 vs. 22,4 ± 1.7 μg/dl; P < 0.05) and urinary levels of isoprostanes (221.1 ± 10.5 vs. 132.6 ± 8.7 ng/mg; P < 0.05).
This is the first study showing an increased oxidative stress in primary aldosteronism, characterized by increased serum levels of Nox2-dp and urinary excretion of isoprostanes. After APA removal with laparoscopic adrenalectomy, we found reduction of serum Nox2-dp and urinary isoprostanes.
原发性醛固酮增多症是继发性高血压的一种重要形式，与心血管风险显著增加（缺血性心脏病、脑血管事件、心律失常）相关（相对风险4.6）。原发性醛固酮增多症的特异性治疗可显著降低心血管风险。除了高血压值和醛固酮的直接作用外，氧化应激增加等新机制也参与了器官损害、代谢、内皮和凝血并发症的发生发展。
本研究旨在评估38例原发性醛固酮增多症患者（21例男性，17例女性，平均年龄53.3±4.7岁）[11例醛固酮瘤（APA）（4例男性，7例女性，平均年龄50.2±4.5岁）和27例特发性肾上腺增生（IHA）（17例男性，10例女性，平均年龄54.5±5.3岁）]在诊断时及特异性治疗（手术或药物治疗）后的氧化应激参数，并与50例原发性高血压患者（26例男性，24例女性，平均年龄49±7.4岁）和50例健康个体（28例男性，22例女性，平均年龄48.7±4.4岁）进行比较。
原发性醛固酮增多症患者的烟酰胺腺嘌呤二核苷酸磷酸氧化酶（Nox₂-dp）血浆水平和尿中异前列腺素显著升高（分别为34.9±4.3μg/dl和216.3±15.7ng/mg；P<0.05），高于原发性高血压患者（分别为27.1±3.7μg/dl和144.8±9.4ng/mg；P<0.05）。在接受肾上腺切除术的APA患者中，我们观察到Nox₂-dp循环水平（29±2.1 vs. 22.4±1.7μg/dl；P<0.05）和尿中异前列腺素水平（221.1±10.5 vs. 132.6±8.7ng/mg；P<0.05）均显著降低。
这是第一项显示原发性醛固酮增多症中氧化应激增加的研究，其特征为血清Nox₂-dp水平升高和尿中异前列腺素排泄增加。在通过腹腔镜肾上腺切除术切除APA后，我们发现血清Nox₂-dp和尿中异前列腺素减少。
