CARDIOVASCULAR AND GLUCO-METABOLIC COMPLICATIONS IN PATIENTS WITH PRIMARY HYPERALDOSTERONISM

Abstract

Objective: Primary hyperaldosteronism (PA) is an under-diagnosed cause of hypertension. The presentation is classically known to occur in a patient with hypertension and hypokalemia. However, in reality, most patients will present without hyperkalemia. PA is characterized by the development of cardiovascular, renal and metabolic complications, including left ventricular hypertrophy, myocardial infarction, atrial fibrillation and stroke, microalbuminuria, as well as metabolic syndrome. The aim of our study was to assess the metabolic, renal, and cardiovascular alterations, in patients with primary hyperaldosteronism. Design and method: It’s a retrospective study with 50 patients with a primary hyperaldosteronism (aldosterone-producing adenoma: n = 34; adrenal hyperplasia: n = 16). In all patients were collected clinical and biological data, as well as electrocardiogram and cardiac ultrasound. Cardiovascular risk was assessed using the ASCVD risk score. Results: There were 34 (68 %) women and 16 (32%) men, with a mean age at the diagnosis of hypertension of 41.7 ± 10.9 years. Overweight, obesity, diabetes mellitus, dyslipidemia, and metabolic syndrome were diagnosed in 34, 48, 31, 44, and 71% of cases, respectively. Hypokalemia was present in 30 patients (60 %). Kalaemia was negatively correlated with plasma aldosterone level (P = 0.013). Albuminuria and chronic renal failure were found in 57 and 18% of cases, respectively. The average 10-year ASCVD risk was 18.6 ± 12.4%. It was significantly correlated with age, fasting glucose (P = 0.013), glycated hemoglobin (P = 0.008), triglycerides level (P = 0.005), and creatinine level (P = 0.001). 26% of patients had a low risk, 21% had a moderate risk and 53 % had a high risk. 31% had subepicardial ischemia, 59% had left ventricular hypertrophy and 10% had a low left ventricular ejection fraction. A history of stroke was found in 18% of patients. Conclusions: Aldosterone is a key mediator of the cardiometabolic syndrome in primary aldosteronism. PA is associated with a high prevalence of metabolic disorders and renal disease. These complications are significantly associated with cardiovascular risk.