Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Endocrinology, Helsinki University Hospital and Research Programs Unit, Clinical and Molecular Medicine, University of Helsinki, Helsinki, Finland.
Am J Hypertens. 2024 Oct 14;37(11):884-892. doi: 10.1093/ajh/hpae087.
The incidence of cardiovascular complications may be higher in unilateral than bilateral primary aldosteronism (PA). We compared noninvasive hemodynamics after targeted therapy of bilateral vs. unilateral PA.
Adrenal vein sampling was performed, and hemodynamics recorded using radial artery pulse wave analysis and whole-body impedance cardiography (n = 114). In 40 patients (adrenalectomy n = 20, spironolactone-based treatment n = 20), hemodynamic recordings were performed after 33 months of PA treatment.
In initial cross-sectional analysis, 51 patients had bilateral and 63 unilateral PA. The mean ages were 50.6 and 54.3 years (P = 0.081), and body mass indexes 30.3 and 30.6 kg/m2 (P = 0.724), respectively. Aortic blood pressure (BP) and cardiac output did not differ between the groups, but left cardiac work was ~10% higher in unilateral PA (P = 0.022). In the follow-up study, initial and final BPs in the aorta were not significantly different, while initial cardiac output (+13%, P = 0.015) and left cardiac work (+17%, P = 0.009) were higher in unilateral than bilateral PA. After median treatment of 33 months, the differences in cardiac load were abolished, and extracellular water volume was reduced by 1.3 and 1.4 l in bilateral vs. unilateral PA, respectively (P = 0.814).
These results suggest that unilateral PA burdens the heart more than bilateral PA, providing a possible explanation for the higher incidence of cardiac complications in unilateral disease. A similar reduction in aldosterone-induced volume excess was obtained with targeted surgical and medical treatment of PA.
心血管并发症的发生率在单侧原发性醛固酮增多症（PA）中可能高于双侧。我们比较了双侧与单侧 PA 靶向治疗后的非侵入性血液动力学。
进行肾上腺静脉采样，并使用桡动脉脉搏波分析和全身阻抗心动图记录血液动力学（n=114）。在 40 例患者（肾上腺切除术 n=20，螺内酯治疗 n=20）中，在 PA 治疗 33 个月后进行血液动力学记录。
在初始横断面分析中，51 例患者为双侧，63 例为单侧 PA。平均年龄分别为 50.6 岁和 54.3 岁（P=0.081），体重指数分别为 30.3 和 30.6kg/m2（P=0.724）。主动脉血压（BP）和心输出量在两组之间没有差异，但单侧 PA 的左心工作量高约 10%（P=0.022）。在随访研究中，主动脉的初始和最终 BP 没有显著差异，而初始心输出量（+13%，P=0.015）和左心工作量（+17%，P=0.009）在单侧 PA 中更高。中位治疗 33 个月后，心脏负荷的差异消失，双侧和单侧 PA 的细胞外液体积分别减少 1.3 和 1.4L（P=0.814）。
这些结果表明，单侧 PA 比双侧 PA 对心脏的负担更大，为单侧疾病中心血管并发症发生率较高提供了一个可能的解释。通过对 PA 的靶向手术和药物治疗，可获得类似的醛固酮诱导的容量过多减少。
