Department of Internal Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan.
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
J Hum Hypertens. 2021 Feb;35(2):131-147. doi: 10.1038/s41371-020-00426-y. Epub 2020 Oct 16.
Primary aldosteronism (PA) is a common cause of secondary hypertension and is associated with worse cardiovascular outcomes. The elevated aldosterone in PA leads to left ventricular (LV) remodeling and dysfunction. In recent decades, clinical studies have demonstrated worse LV remodeling including increased LV mass and cardiac fibrosis in patients with PA compared to patients with essential hypertension. Several mechanisms may explain the process of aldosterone-induced LV remodeling, including directly profibrotic and hypertrophic effects of aldosterone on myocardium, increased reactive oxygen species and profibrotic molecules, dysregulation of extracellular matrix metabolism, endothelium dysfunction and circulatory macrophages activation. LV remodeling causes LV diastolic and systolic dysfunction, which may consequently lead to clinical complications such as heart failure, atrial fibrillation, ischemic heart disease, and other vascular events. Adequate treatment with adrenalectomy or medical therapy can improve LV remodeling and dysfunction in PA patients. In this review, we discuss the mechanisms of aldosterone-induced LV remodeling and provide an up-to-date review of clinical research about LV remodeling-related heart structural changes, cardiac dysfunction, and their clinical impacts on patients with PA.
原醛症（PA）是继发性高血压的常见病因，与心血管结局恶化相关。PA 中升高的醛固酮导致左心室（LV）重构和功能障碍。近几十年来，临床研究表明，与原发性高血压患者相比，PA 患者的 LV 重构更差，包括 LV 质量增加和心肌纤维化。几种机制可能解释醛固酮诱导的 LV 重构过程，包括醛固酮对心肌的直接促纤维化和促肥厚作用、活性氧和促纤维化分子增加、细胞外基质代谢失调、内皮功能障碍和循环巨噬细胞激活。LV 重构导致 LV 舒张和收缩功能障碍，可能导致心力衰竭、心房颤动、缺血性心脏病和其他血管事件等临床并发症。通过肾上腺切除术或药物治疗进行充分治疗可以改善 PA 患者的 LV 重构和功能障碍。在这篇综述中，我们讨论了醛固酮诱导的 LV 重构的机制，并对 LV 重构相关的心脏结构变化、心功能障碍及其对 PA 患者的临床影响的临床研究进行了最新综述。
