Cardiovascular Complications Associated With Primary Aldosteronism

TLDR

Patients with primary aldosteronism have a higher risk of cardiovascular events than those with essential hypertension, but evidence is limited by small sample sizes and potential confounding. The authors compared cardiovascular event prevalence in 459 PA patients versus 1,290 matched EH controls and argued that organ damage disproportionate to blood pressure should prompt PA suspicion and broader screening. PA and EH patients were individually matched for sex, age, and office systolic blood pressure, and the prevalence of cardiovascular events was compared in the two groups. PA patients exhibited significantly higher prevalence of left ventricular hypertrophy, coronary artery disease, nonfatal myocardial infarction, heart failure, and atrial fibrillation, with risks similar across serum potassium and aldosterone levels, indicating they are more likely to have had cardiovascular complications at diagnosis.

Abstract

A higher risk of cardiovascular events has been reported in patients with primary aldosteronism (PA) than in otherwise similar patients with essential hypertension (EH). However, the evidence is limited by small sample size and potential confounding factors. We, therefore, compared the prevalence of cardiovascular events in 459 patients with PA diagnosed in our hypertension unit from 2001 to 2006 and 1290 controls with EH. PA cases and EH controls were individually matched for sex, age (±2 years), and office systolic blood pressure (±10 mm Hg). Patients with PA and EH differed significantly in duration of hypertension, serum potassium, plasma aldosterone and plasma renin concentrations, aldosterone-to-renin ratio, and urinary aldosterone concentration (P<0.001 for all comparisons). The prevalence of electrocardiographic and echocardiographic left ventricular hypertrophy was about twice higher in patients with PA even after adjustment for hypertension duration. PA patients also had a significantly higher prevalence of coronary artery disease (adjusted odds ratio, 1.9), nonfatal myocardial infarction (adjusted odds ratio, 2.6), heart failure (adjusted odds ratio, 2.9), and atrial fibrillation (adjusted odds ratio, 5.0). The risks associated with PA were similar across levels of serum potassium and plasma aldosterone. To conclude, patients with PA are more likely to have had a cardiovascular complication at diagnosis than otherwise similar patients with EH. Target organ damage and complications disproportionate to blood pressure should be considered as an additional argument for suspecting PA in a given individual and possibly for broadening the scope of screening at the population level.