Petramala L, Concistrè A, Mezzadri M, Sarlo F, Circosta F, Schina M, Soldini M, Iannucci G, Letizia C
Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy.
University Cattolica "Sacro Cuore", Rome, Italy.
Int J Cardiol Cardiovasc Risk Prev. 2022 Jun 6;14:200138. doi: 10.1016/j.ijcrp.2022.200138. eCollection 2022 Sep.
Aldosterone plays important role in cardiovascular damage. Aim was to evaluate arterial subclinical damage through arterial stiffness parameters in patients with Essential Hypertension (EH) and Primary Aldosteronism (PA).
From 2018 to 2019 we consecutively enrolled 82 subjects (37 males and 45 women), distinguished in two groups: 60 EH [systolic blood pressure (SBP) 143.4 ± 16.7 mmHg, diastolic blood pressure (DBP) 89.5 ± 12.1 mmHg] and 22 PA (SBP 149 ± 19.5 mmHg, DBP 92.7 ± 12.4 mmHg) [5 with aldosterone-secreting adrenal adenoma(APA), 17 with idiopathic aldosteronism(IHA)]; 40 matched normotensive subjects (NS) were enrolled (SBP 109.7 ± 6.2 mmHg, DBP 71.3 ± 9.7 mmHg). We used non-invasive applanation tonometer to acquire pressure waveform.
PA patients showed higher μ-Albuminuria (UAE) (65.7 ± 11.0mg/24 h) than EH and NS (21.5 ± 7.0 mg/24 h and 21.5 ± 7.0 mg/24 h, respectively); APA group showed increased levels of arterial stiffness index (11.7 ± 4.8 m/s; p < 0.02) compared to EH subjects (8.3 ± 3 m/s) and NS subjects (7.2 ± 1.7 m/s) as well as higher carotid intima-media thickness (c-IMT); APA patients showed significant reduction of subendocardial viability ratio (SEVR) and travel time of the reflected waves (TI) respect EH and NS. PA groups showed high percentage of augmented "worsening age" (60%), compared to EH (38%) and NS (37%). PAC was positively correlated with Arterial Stiffness Index. Performing multiple linear regression analysis (evaluating anthropometric and biochemical parameters), we found UAE as predictor of Augmentation Index, Arterial Stiffness Index and Travel Time of reflected waves in the enrolled population.
PA patients showed higher cardiovascular subclinical damage respect to EH; UAE excretion had significant correlation with aldosterone, resulting best marker of subclinical vascular remodeling.
醛固酮在心血管损伤中起重要作用。本研究旨在通过动脉僵硬度参数评估原发性高血压（EH）和原发性醛固酮增多症（PA）患者的动脉亚临床损伤情况。
2018年至2019年，我们连续纳入了82名受试者（37名男性和45名女性），分为两组：60名EH患者[收缩压（SBP）143.4±16.7mmHg，舒张压（DBP）89.5±12.1mmHg]和22名PA患者（SBP 149±19.5mmHg，DBP 92.7±12.4mmHg）[5例为醛固酮分泌性腺瘤（APA），17例为特发性醛固酮增多症（IHA）]；同时纳入40名匹配的血压正常受试者（NS）（SBP 109.7±6.2mmHg，DBP 71.3±9.7mmHg）。我们使用无创压平眼压计获取压力波形。
PA患者的微量白蛋白尿（UAE）水平（65.7±11.0mg/24h）高于EH患者和NS受试者（分别为21.5±7.0mg/24h和21.5±7.0mg/24h）；与EH受试者（8.3±3m/s）和NS受试者（7.2±1.7m/s）相比，APA组的动脉僵硬度指数水平升高（11.7±4.8m/s；p<0.02），颈动脉内膜中层厚度（c-IMT）也更高；与EH患者和NS受试者相比，APA患者的心内膜下存活比（SEVR）和反射波传播时间（TI）显著降低。与EH患者（38%）和NS受试者（37%）相比，PA组中“年龄恶化”增加的比例较高（60%）。血浆醛固酮浓度（PAC）与动脉僵硬度指数呈正相关。进行多元线性回归分析（评估人体测量和生化参数）时，我们发现UAE是所纳入人群中增强指数、动脉僵硬度指数和反射波传播时间的预测指标。
与EH患者相比，PA患者的心血管亚临床损伤更严重；UAE排泄与醛固酮显著相关，是亚临床血管重塑的最佳标志物。
