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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
,
Holger Schneider 
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].
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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.

Key words

aldosterone - pulse wave velocity - intima media thickness - hypertension - atherosclerosis - atherosclerotic plaque


Publication History

Received: 04 September 2020

Accepted after revision: 23 November 2020

Article published online:
13 January 2021

© 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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  • References

  • 1 Monticone S, Burrello J, Tizzani D. et al. Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice. J Am Coll Cardiol 2017; 69: 1811-1820
    CrossrefPubMedGoogle Scholar
  • 2 Rossi GP, Bernini G, Caliumi C. et al. A prospective study of the prevalence of primary aldosteronism in 1125 hypertensive patients. J Am Coll Cardiol 2006; 48: 2293-2300
    CrossrefPubMedGoogle Scholar
  • 3 Reincke M, Seiler L, Rump LC. Normokaliämischer primärer Hyperaldosteronismus. Dtsch Arztebl 2003; 100
    PubMedGoogle Scholar
  • 4 Heinrich DA, Adolf C, Rump LC. et al. Primary aldosteronism: key characteristics at diagnosis: a trend toward milder forms. Eur J Endocrinol 2018; 178: 605-611
    CrossrefPubMedGoogle Scholar
  • 5 Monticone S, D’Ascenzo F, Moretti C. et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2018; 6: 41-50
    CrossrefPubMedGoogle Scholar
  • 6 Milliez P, Girerd X, Plouin PF. et al. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol 2005; 45: 1243-1248
    CrossrefPubMedGoogle Scholar
  • 7 Rocha R, Rudolph AE, Frierdich GE. et al. Aldosterone induces a vascular inflammatory phenotype in the rat heart. Am J Physiol Heart Circ Physiol 2002; 283: H1802-H1810
    CrossrefPubMedGoogle Scholar
  • 8 Brilla CG, Weber KT. Mineralocorticoid excess, dietary sodium, and myocardial fibrosis. J Lab Clin Med 1992; 120: 893-901
    Google Scholar
  • 9 Young M, Fullerton M, Dilley R. et al. Mineralocorticoids, hypertension, and cardiac fibrosis. J Clin Invest 1994; 93: 2578-2583
    CrossrefPubMedGoogle Scholar
  • 10 Chen ZW, Tsai CH, Pan CT. et al. Endothelial dysfunction in primary aldosteronism. Int J Mol Sci 2019; 20
    PubMedGoogle Scholar
  • 11 Ambrosino P, Lupoli R, Tortora A. et al. Cardiovascular risk markers in patients with primary aldosteronism: A systematic review and meta-analysis of literature studies. Int J Cardiol 2016; 208: 46-55
    CrossrefPubMedGoogle Scholar
  • 12 Bernini G, Galetta F, Franzoni F. et al. Arterial stiffness, intima-media thickness and carotid artery fibrosis in patients with primary aldosteronism. J Hypertens 2008; 26: 2399-2405
    CrossrefPubMedGoogle Scholar
  • 13 Lin YH, Lin LY, Chen A. et al. Adrenalectomy improves increased carotid intima-media thickness and arterial stiffness in patients with aldosterone producing adenoma. Atherosclerosis 2012; 221: 154-159
    CrossrefPubMedGoogle Scholar
  • 14 Holaj R, Zelinka T, Wichterle D. et al. Increased intima-media thickness of the common carotid artery in primary aldosteronism in comparison with essential hypertension. J Hypertens 2007; 25: 1451-1457
    CrossrefPubMedGoogle Scholar
  • 15 Holaj R, Rosa J, Zelinka T. et al. Long-term effect of specific treatment of primary aldosteronism on carotid intima-media thickness. J Hypertens 2015; 33: 874-882 discussion 882
    CrossrefPubMedGoogle Scholar
  • 16 Rosa J, Somloova Z, Petrak O. et al. Peripheral arterial stiffness in primary aldosteronism. Physiol Res 2012; 61: 461-468
    CrossrefPubMedGoogle Scholar
  • 17 Tsioufis C, Tsiachris D, Dimitriadis K. et al. Myocardial and aortic stiffening in the early course of primary aldosteronism. Clin Cardiol 2008; 31: 431-436
    CrossrefPubMedGoogle Scholar
  • 18 Murata M, Kitamura T, Tamada D. et al. Plasma aldosterone level within the normal range is less associated with cardiovascular and cerebrovascular risk in primary aldosteronism. J Hypertens 2017; 35: 1079-1085
    CrossrefPubMedGoogle Scholar
  • 19 Adolf C, Kohler A, Franke A. et al. Cortisol excess in patients with primary aldosteronism impacts left ventricular hypertrophy. J Clin Endocrinol Metab 2018; 103: 4543-4552
    CrossrefPubMedGoogle Scholar
  • 20 Funder JW, Carey RM, Mantero F. et al. The management of primary aldosteronism: Case detection, diagnosis, and treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016; 101: 1889-1916
    CrossrefPubMedGoogle Scholar
  • 21 Betz MJ, Degenhart C, Fischer E. et al. Adrenal vein sampling using rapid cortisol assays in primary aldosteronism is useful in centers with low success rates. Eur J Endocrinol 2011; 165: 301-306
    CrossrefPubMedGoogle Scholar
  • 22 Aboyans V, Criqui MH, Abraham P. et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation 2012; 126: 2890-2909
    CrossrefPubMedGoogle Scholar
  • 23 Abedin M, Tintut Y, Demer LL. Vascular calcification: mechanisms and clinical ramifications. Arterioscler Thromb Vasc Biol 2004; 24: 1161-1170
    CrossrefPubMedGoogle Scholar
  • 24 Pizarro C, Schaefer C, Kimeu I. et al. Underdiagnosis of obstructive sleep apnoea in peripheral arterial disease. Respiration 2015; DOI: 10.1159/000371355.
    CrossrefPubMedGoogle Scholar
  • 25 Youssef A, Kalaja I, Alkomi U. et al. Aortic stiffness and related complications after endovascular repair of blunt thoracic aortic injury in young patients. Vasa 2020; 49: 295-300
    CrossrefPubMedGoogle Scholar
  • 26 Touboul PJ, Hennerici MG, Meairs S. et al. Mannheim intima-media thickness consensus. Cerebrovasc Dis 2004; 18: 346-349
    CrossrefPubMedGoogle Scholar
  • 27 Griffin M, Nicolaides A, Tyllis T. et al. Carotid and femoral arterial wall changes and the prevalence of clinical cardiovascular disease. Vasc Med 2009; 14: 227-232
    CrossrefPubMedGoogle Scholar
  • 28 Gurtelschmid M, Bjorck M, Wanhainen A. Comparison of three ultrasound methods of measuring the diameter of the abdominal aorta. Br J Surg 2014; 101: 633-636
    CrossrefPubMedGoogle Scholar
  • 29 Lekakis JP, Papamichael C, Papaioannou TG. et al. Intima-media thickness score from carotid and femoral arteries predicts the extent of coronary artery disease: intima-media thickness and CAD. Int J Cardiovasc Imaging 2005; 21: 495-501
    CrossrefPubMedGoogle Scholar
  • 30 Matsuda Y, Kawate H, Matsuzaki C. et al. Eplerenone improves carotid intima-media thickness (IMT) in patients with primary aldosteronism. Endocr J 2016; 63: 249-255
    CrossrefPubMedGoogle Scholar
  • 31 Adolf C, Asbach E, Dietz AS. et al. Worsening of lipid metabolism after successful treatment of primary aldosteronism. Endocrine 2016; 54: 198-205
    CrossrefPubMedGoogle Scholar
  • 32 Kalizki T, Schmidt BMW, Raff U. et al. Low dose-eplerenone treatment decreases aortic stiffness in patients with resistant hypertension. J Clin Hypertens (Greenwich) 2017; 19: 669-676
    CrossrefPubMedGoogle Scholar
  • 33 Ando K, Ohtsu H, Uchida S. et al. Anti-albuminuric effect of the aldosterone blocker eplerenone in non-diabetic hypertensive patients with albuminuria: a double-blind, randomised, placebo-controlled trial. Lancet Diabetes Endocrinol 2014; 2: 944-953
    CrossrefPubMedGoogle Scholar
  • 34 Chamarthi B, Williams GH, Ricchiuti V. et al. Inflammation and hypertension: the interplay of interleukin-6, dietary sodium, and the renin-angiotensin system in humans. Am J Hypertens 2011; 24: 1143-1148
    CrossrefPubMedGoogle Scholar
  • 35 Grotevendt A, Wallaschofski H, Reincke M. et al. Associations of aldosterone and renin concentrations with inflammation-the Study of Health in Pomerania and the German Conn’s Registry. Endocrine 2017; 57: 298-307
    CrossrefPubMedGoogle Scholar
  • 36 Goncalves I, Edsfeldt A, Colhoun HM. et al. Association between renin and atherosclerotic burden in subjects with and without type 2 diabetes. BMC Cardiovasc Disord 2016; 16: 171
    CrossrefPubMedGoogle Scholar
  • 37 Suzuki Y, Ruiz-Ortega M, Lorenzo O. et al. Inflammation and angiotensin II. Int J Biochem Cell Biol 2003; 35: 881-900
    CrossrefPubMedGoogle Scholar
  • 38 Inaba Y, Chen JA, Bergmann SR. Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: a meta-analysis. Atherosclerosis 2012; 220: 128-133
    CrossrefPubMedGoogle Scholar
  • 39 Johri AM, Nambi V, Naqvi TZ. et al. Recommendations for the Assessment of Carotid Arterial Plaque by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk: From the American Society of Echocardiography. J Am Soc Echocardiogr. 2020
    Google Scholar
  • 40 Laclaustra M, Casasnovas JA, Fernandez-Ortiz A. et al. Femoral and carotid subclinical atherosclerosis association with risk factors and coronary calcium: The AWHS Study. J Am Coll Cardiol 2016; 67: 1263-1274
    CrossrefPubMedGoogle Scholar