Comparison of left ventricular structure and function in primary aldosteronism and essential hypertension by echocardiography.

Abstract

Primary aldosteronism (PA) is the most common secondary cause of hypertension. The present study investigated differences in left ventricular structure and function between hypertensive patients with PA and sucjects with essential hypertension (EH). One hundred patients with PA and 100 controls with EH were matched for age, gender, and 24-h ambulatory monitoring blood pressure (BP). Left ventricular mass index (LVMI), left atrial volume index (LAVI) and ejection fraction were calculated. LV diastolic function was estimated as the ratio of the early diastolic velocities (E) from transmitral inflow to the early diastolic velocities (e') of tissue Doppler at mitral annulus. PA and EH patients had similar LV dimensions, LV wall thicknesses, LVMI and LV systolic function. PA was associated with greater impairment in diastolic function, as reflected by the lower e' (P=0.004), higher E/e' ratio (P=0.005) and higher LAVI (P=0.02). The LV geometric dimensions and patterns of LV hypertrophy were similar between male patients from the PA and EH groups. However, in female patients, PA was correlated with higher LV internal dimensions (P=0.001), higher LVMI (P=0.04) and lower relative wall thickness (RWT, P=0.001). Multivariate analysis showed that LV diastolic function was independently correlated with age (β=0.416, P<0.001), 24-h systolic BP (β=0.238, P=0.016) and serum potassium (β=-0.201, P=0.036) in PA patients. In conclusion, PA appears to contribute to the impairment of LV diastolic function in both sexes as well as the higher prevalence of eccentric hypertrophy in women than in men compared with EH. Age, 24-h systolic BP and serum potassium levels are independent risk factors for LV diastolic function in PA patients.