CC BY-NC-ND 4.0 · Horm Metab Res 2021; 53(03): 178-184
DOI: 10.1055/a-1326-2164
Endocrine Care

Atherosclerotic Burden and Arterial Stiffness are Not Increased in Patients with Milder Forms of Primary Aldosteronism Compared to Patients with Essential Hypertension

Christian Lottspeich
1  Medizinische Klinik und Poliklinik IV, LMU München, Munich, Germany
,
Anton Köhler
1  Medizinische Klinik und Poliklinik IV, LMU München, Munich, Germany
,
Michael Czihal
1  Medizinische Klinik und Poliklinik IV, LMU München, Munich, Germany
,
Daniel A. Heinrich
1  Medizinische Klinik und Poliklinik IV, LMU München, Munich, Germany
,
1  Medizinische Klinik und Poliklinik IV, LMU München, Munich, Germany
,
Laura Handgriff
1  Medizinische Klinik und Poliklinik IV, LMU München, Munich, Germany
,
Martin Reincke
1  Medizinische Klinik und Poliklinik IV, LMU München, Munich, Germany
,
Christian Adolf
1  Medizinische Klinik und Poliklinik IV, LMU München, Munich, Germany
› Author Affiliations
Funding Information This work was supported by the Else Kröner-Fresenius Stiftung in support of the German Conn’s Registry-Else-Kröner Hyperaldosteronism Registry (2013_A182, 2015_A171 and 2019_A104 to MR), the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No 694913 to MR), and by the Deutsche Forschungsgemeinschaft (DFG) [within the CRC/Transregio 205/1 “The Adrenal: Central Relay in Health and Disease” to CA, DAH, HS and MR and within the Clinician Scientist PRogram In Vascular MEdicine (PRIME) MA 2186/14–1 to HS].

Abstract

Patients with primary aldosteronism (PA) are at increased cardiovascular risk, compared to patients with essential hypertension (EH). Cardiovascular damage could depend on PA phenotype, potentially being lower in milder forms of PA. Our aim was to assess atherosclerotic burden and arterial stiffness in 88 prospectively recruited patients, including 44 patients with mild PA and EH respectively. All patients underwent a structured study program, including measurements of ankle-brachial index, oscillometric measurement of central pulse wave velocity (cPWV) and vascular ultrasound examination of the supraaortic arteries, the abdominal aorta, and the femoropopliteal arteries. A plaque score was calculated to estimate atherosclerotic burden for each patient. This is a prospective case-control study set at a tertiary care hospital. Patients with PA and EH matched well for age, gender, blood pressure, BMI, and cardiovascular risk factors such as diabetes mellitus and smoking status. Common carotid intima-media thickness (0.77 vs. 0.75 mm; p=0.997) and cPWV (7.2 vs. 7.1 m/s; p=0.372) were comparable between patients with PA and EH. The atherosclerotic burden, as expressed by the plaque score, did not differ between the two groups (p=0.159). However, after initiation of treatment cPWV was significantly decreased in patients with PA (p=0.017). This study shows that subclinical atherosclerotic burden and arterial stiffness in patients with milder forms of PA is comparable to patients with EH. Nevertheless, specific treatment for PA significantly improved cPWV, which argues for a more liberal use of mineralocorticoid receptor antagonists in patients with arterial hypertension.



Publication History

Received: 04 September 2020

Accepted after revision: 23 November 2020

Publication Date:
13 January 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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