Abstract
Purpose: Patients with primary aldosteronism (PA) have an increased risk of target-organ damage (TOD), but whether metabolic syndrome (MetS) is more prevalent and contributes to TOD in PA patients remains unresolved. We aimed to evaluate the associations between MetS profiles and TOD in Chinese PA individuals.Methods: Metabolic parameters and pre-clinical TOD including left ventricular hypertrophy, estimated glomerular filtration, and microalbuminuria; insulin sensitivity or resistance; and islet β-cell function were assessed by the homeostasis models (HOMA-IR, HOMA-β) and the other surrogate indexes [composite insulin sensitivity index (ISI), modified β-cell function index (MBCI)] determined from the oral glucose tolerance test were compared in PA vs. matched essential hypertension (EH) patients.Results: A total of 109 PA patients and 109 essential hypertension (EH) controls individually matched for sex, age, and office systolic blood pressure and duration of hypertension were studied. The prevalence of MetS and its individual components in PA was significantly lower than in EH [MetS: 28 (25.6%) vs. 54 (49.5%), P < 0.001]. PA patients had a higher composite ISI but a lower HOMA-IR, HOMA-β, and MBCI than EH controls (all P < 0.05). Concerning TOD, PA patients had significantly higher prevalence of microalbuminuria and left ventricular hypertrophy (LVH), and lower levels of estimated glomerular filtration (eGFR) than EH controls (all P < 0.05). On multivariate logistic regression analysis, female gender and elevated plasma aldosterone levels were significantly associated with TOD in PA. However, there were no significant associations between MetS and its individual components and TOD in PA patients.Conclusions: PA patients had a lower MetS prevalence but exhibited more severe TOD than matched EH controls. The study highlights the deleterious effects of aldosterone excess on the development of TOD, whereas MetS or its individual components might be less influential in PA.
Highlights
Primary aldosteronism (PA) is the most frequent cause of endocrine hypertension, characterized by the autonomous aldosterone overproduction followed by suppressed plasma renin activity (PRA)
Compared with age, sex, and blood pressure (BP)-matched patients with essential hypertension (EH), PA patients have an increased risk of cardiovascular events, including stroke, myocardial infarction, diastolic dysfunction and heart failure, and atrial fibrillation [4, 5], which is closely associated with antecedent pre-clinical targetorgan damage (TOD) and increased cardiovascular remodeling, such as left ventricular hypertrophy (LVH), artery stiffness and calcification, widespread tissue inflammation, and fibrosis [6, 7]
Among the 130 PA patients, 21 PA patients were excluded for meeting exclusion criteria; a total of 109 PA cases and 109 matched EH controls were enrolled in this study (Figure 1)
Summary
Primary aldosteronism (PA) is the most frequent cause of endocrine hypertension, characterized by the autonomous aldosterone overproduction followed by suppressed plasma renin activity (PRA). Investigations of different populations suggest that PA affects about 10% of unselected patients with hypertension [1] and is common in patients with resistant hypertension, with prevalence as high as 20% [2]. The controversy appeared to be settled by a recent large meta-analysis including both prospective and retrospective observational, mostly non-matched studies, which found a slightly increased prevalence of diabetes mellitus (DM) and MetS in patients with PA [5]; the heterogeneity in the diagnosis of MetS, different matching methods, potential selection biases, and the relatively few studies from Asia might affect the results. Whether MetS prevalence in PA is greater and confers an increased risk of TOD deserves more clinical and research attention, especially in Chinese population
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