Hypertension caused by primary hyperaldosteronism: Increased heart damage and cardiovascular risk in Algerian cohort

Abstract

Primary hyperaldosteronism is the most common cause of secondary hypertension. Elevated aldosterone levels cause heart damage and increase cardiovascular morbidity and mortality. Early diagnosis could change the course of this entity. The objective of this report was to study the clinical characteristics, cardiac damage and cardiovascular risk associated with primary hyperaldosteronism in algerian cohort. We studied 149 patients with this diagnosis. We analyzed the reason for etiological investigation, and the routinely performed tests, including echocardiography. We used a cohort of 590 essential hypertensive patients followed in our hospital for comparison. Compared with essential hypertensive patients, those with hyperaldosteronism were younger [56.9 (11.7) years vs. 60 (14.4) years; P < 0.001], had higher blood pressure prior to the etiological diagnosis [156 (23.2) mmHg vs. 136 (20.6) mmHg], more frequently had a family history of early cardiovascular disease (26.7% vs. 2.3%; P < 0.001), and had a higher prevalence of concentric left ventricular hypertrophy (72% vs. 25.4%) and higher cardiovascular risk. Specific treatment resulted in optimal control of systolic and diastolic blood pressures (from 150.7 [23.0] mmHg and 86.15 [14.07] mmHg to 12.69 [15.3] mmHg and 76.34 [9.7] mmHg, respectively). We suspected the presence of hyperaldosteronism because of resistant hypertension (38.6%), hypokalemia (39.7%), and hypertensive crises (12.7%). Only 4.3% of these patients had been referred from primary care with a suspected diagnosis of hyperaldosteronism. Hyperaldosteronism should be suspected in cases of resistant hypertension, hypokalemia and hypertensive crises. The diagnosis of hyperaldosteronism allows better blood pressure control. The most prevalent target organ damage is left ventricular hypertrophy.