Comparisons of microvascular and macrovascular changes in aldosteronism-related hypertension and essential hypertension

Monica Varano,Barbara Boccassini,Mario Curione,Cristiano Marinelli,Massimiliano M Tedeschi,Claudio Savoriti,Claudio Letizia,Laura Zinnamosca,Pierluigi Iacono,Mariacristina Parravano,Erika Baiocco

doi:10.1038/s41598-017-02622-2

Abstract

Case-control observational study to evaluate the microvascular and macrovascular changes in patients with hypertension secondary to primary aldosteronism (PA), essential hypertension (EH) and healthy subjects. Measurements of arterial stiffness including augmentation index (AIx) and pulse wave velocity (PWV) were assessed using a TensioClinic arteriograph system. Retinal microcirculation was imaged by a Retinal Vessel Analyzer (RVA) and a non-midriatic camera (Topcon-TRC-NV2000). IMEDOS software analyzed the retinal artery diameter (RAD), retinal vein diameters (RVD) and arteriole-to-venule ratio (AVR) of the vessels coming off the optic disc. Thirty, 39 and 35 patients were included in the PA, EH and control group, respectively. The PA group showed higher PWV values compared only with the control group. The mean brachial and aortic AIx values did not show significant difference between groups. In the PA group, the mean RVD and AVR values were significantly lower than in the EH and control groups, whereas the parameters did not differ between the EH and control groups. In conclusion, AVR appears significantly modified in the PA group compared with the EH group and could represent an early and more reliable indicator of microvascular remodeling.

Highlights

Primary aldosteronism (PA) is a common cause of arterial hypertension and represents the most frequent form of secondary hypertension[1]
There were no significant differences in age, gender and smoking habits between the groups; the body mass index was significantly lower in the control group, whereas it appeared similar in patients with Primary Aldosteronism (PA) and essential hypertension (EH)
Systolic and Diastolic blood pressure (BP), both measured in the clinic and during 24-hour ambulatory blood pressure monitoring (ABPM), were comparable in patients with PA and EH and were found to be statistically different from the patients in the control group

Summary

Introduction

Primary aldosteronism (PA) is a common cause of arterial hypertension and represents the most frequent form of secondary hypertension[1]. Recent studies of patients affected by PA have demonstrated an increased accumulation of collagen, especially type III, even in small arteries and arterioles, compared with normotensive and essential hypertensive subjects[3, 4]. These changes in extracellular matrix are able to modify profoundly the microvascular structure and play an important role in the development of cardiovascular fibrosis and the consequent increase in the rigidity of such structures. The only possible in vivo evaluation of these changes involves an invasive approach through biopsy[4] For this reason, there is currently considerable interest in research on the development of non-invasive methods used in the study of vascular remodeling and arterial stiffness alterations. Arterioles and venules and of their modifications in relation to systemic disease processes such as hypertension and diabetes

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