Cerebro-Cardiovascular Risk, Target Organ Damage, and Treatment Outcomes in Primary Aldosteronism.

Xiao Lin,Xiong Wu,Feng Xu,Li-Min Lei,Su-Kang Shan,Muhammad Hasnain Ehsan Ullah,Ling-Qing Yuan,Jun Liu

doi:10.3389/fcvm.2021.798364

Abstract

Primary aldosteronism (PA) is the most common type of endocrine hypertension, and numerous experimental and clinical evidence have verified that prolonged exposure to excess aldosterone is responsible for an increased risk of cerebro-cardiovascular events and target organ damage (TOD) in patients with PA. Therefore, focusing on restoring the toxic effects of excess aldosterone on the target organs is very important to reduce cerebro-cardiovascular events. Current evidence convincingly demonstrates that both surgical and medical treatment strategies would benefit cerebro-cardiovascular outcomes and mortality in the long term. Understanding cerebro-cardiovascular risk in PA would help clinical doctors to achieve both early diagnosis and treatment. Therefore, in this review, we will summarize the cerebro-cardiovascular risk in PA, focusing on the TOD of aldosterone, including brain, heart, vascular system, renal, adipose tissues, diabetes, and obstructive sleep apnea (OSA). Furthermore, the various treatment outcomes of adrenalectomy and medical treatment for patients with PA will also be discussed. We hope this knowledge will help improve cerebro-cardiovascular prognosis and reduce the incidence and mortality of cerebro-cardiovascular events in patients with PA.

Highlights

Primary aldosteronism (PA) is a clinical syndrome mainly characterized by hypertension, suppressed levels of plasma renin, and autonomous plasma aldosterone overproduction
Rossi et al demonstrated that treatment with mineral ocorticoid receptor antagonist (MRA) had a higher incidence of atrial fibrillation (AF), compared with both ADX treatment for PA and the essential hypertension (EH) group [192], which was confirmed by a recent meta-analysis. This meta-analysis enrolled 2,705 patients with PA, and the results demonstrated that the incidence of new-onset atrial fibrillation (NOAF) among the patients with PA receiving treatment with MRA was much higher compared to those inpatients for PA who underwent ADX
Increasing experimental and clinical data suggest prolonged exposure to elevated aldosterone concentrations in patients with PA is associated with increased target organ damage (TOD), including brain, heart, kidney, vessels, adipose tissues, and obstructive sleep apnea (OSA), and leads to an increase in morbidity from cerebro-cardiovascular events

Summary

Introduction

Primary aldosteronism (PA) is a clinical syndrome mainly characterized by hypertension, suppressed levels of plasma renin, and autonomous plasma aldosterone overproduction. The prevalence of PA in patients with refractory hypertension ranges from 8.9 to 33% [2]. PA is often underestimated, and patients with untreated (or inappropriately treated) PA have an increased risk of cardiovascular events and target organ damage (TOD). A substantial body of clinical studies have demonstrated that undiagnosed PA is associated with stroke, heart failure (HF), diabetes mellitus (DM), obstructive sleep apnea (OSA), renal failure, and other consequential cardiovascular events, along with poorer health-related quality of life (QoL), even premature death [3,4,5,6,7,8]. Prolonged exposure to excess aldosterone has a toxic effect on target organs, including the brain, heart, vascular system, kidney, adipose tissues, and OSA, which could increase the incidence

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Conclusion