LONG-TERM CHANGES OF BLOOD PRESSURE AND LEFT VENTRICULAR (LV) GEOMETRY AFTER ADRENALECTOMY OR MEDICAL TREATMENT FOR PRIMARY ALDOSTERONISM: PP.18.185

Abstract

Objective: To investigate the effects of surgical or medical treatment of primary aldosteronism (PA). Design and Methods: After a baseline Doppler echocardiography assessment (DEA) of LV geometry, 136 patients (age 50.7 ± 13 yrs) with confirmed PA entered a prospective follow-up study with serial DEA after adrenalectomy or medical treatment. Aldosterone producing adenoma (APA) and idiopathic hyper-aldosteronism (IHA) were diagnosed by the 4 corners criteria. Optimally treated primary hypertensive patients (PH) (n = 142) undergoing serial DEA served as controls. Results and Conclusions: Of the PA patients (age 50.7 ± 12.3 yrs, 46%F), 65% had APA and 35% had IHA. At baseline, they showed a high prevalence (52%) of inappropriate LV mass that was similar in the surgically- and the medically-treated group and fell (to 47%) after 3.05 yrs follow-up it. Treatment lowered blood pressure (BP) to almost identical values (136 ± 15/85 ± 8 mmHg) in all groups, but this required more drugs in the medically-treated PA than in the other 2 groups. A decrease of LV mass index (LVMI) was seen in PA and in PH patients; however, in the medically treated PA it did not achieve statistical significance (Table). The fall in LVMI occurred via a decrease of LV end diastolic diameter and volume in both PA groups (p < 0.01), and via a decrease of LV wall thickness in PH patients. This translated into a significant decrease of LV stroke volume and stroke work in PA, but not in PH patients. Hence, more drugs were required to achieve a similar fall of BP in the medically-treated than in the adrenalectomized PA patients., but notwithstanding this higher drugs usage, a significant decrease of LVMI occurred only in the latter patients. However, the remodeling of the LV around a smaller volume translated into a decrease of LV work both in adrenalectomized and in medically treated PA patients.