Long-Term Cardio- and Cerebrovascular Events in Patients With Primary Aldosteronism

TLDR

Aldosterone has a detrimental effect on the cardiovascular system, and patients with primary aldosteronism (PA) exhibit a higher risk of events than those with essential hypertension (EH). The study aimed to compare the incidence of cardio‑ and cerebrovascular events in PA patients versus matched EH controls. Researchers retrospectively analyzed event rates at baseline and over a median 12‑year follow‑up in 270 PA patients matched 1:3 to EH patients, including subtypes aldosterone‑producing adenoma and bilateral adrenal hyperplasia. PA patients experienced higher rates of cardiovascular events, stroke, arrhythmias, and type 2 diabetes, with age, hypertension duration, systolic blood pressure, diabetes, and PA diagnosis independently predicting all events.

Abstract

Aldosterone plays a detrimental role on the cardiovascular system and PA patients display a higher risk of events compared with EH.The objectives of the study were to compare cardio- and cerebrovascular events in patients with primary aldosteronism (PA) and matched essential hypertension (EH).We retrospectively compared the percentage of patients experiencing events at baseline and during a median follow-up of 12 years in 270 PA patients case-control matched 1:3 with EH patients and in PA subtypes [aldosterone-producing adenoma (n = 57); bilateral adrenal hyperplasia (n = 213)] vs matched EH.A significantly higher number of PA patients experienced cardiovascular events over the entire period of the study (22.6% vs 12.7%, P < .001). At the diagnosis of PA, a higher number of patients had experienced total events (14.1% vs 8.4% EH, P = .007); furthermore, during the follow-up period, PA patients had a higher rate of events (8.5% vs 4.3% EH, P = .008). In particular, stroke and arrhythmias were more frequent in PA patients. During the follow-up, a higher percentage of PA patients developed type 2 diabetes. Parameters that were independently associated with the occurrence of all events were age, duration of hypertension, systolic blood pressure, presence of diabetes mellitus, and PA diagnosis. After division into PA subtypes, patients with either aldosterone-producing adenoma or bilateral adrenal hyperplasia displayed a higher rate of events compared with the matched EH patients.This study demonstrates in a large population of patients the pathogenetic role of aldosterone excess in the cardiovascular system and thus the importance of early diagnosis and targeted PA treatment.