OS 35-03 LEFT VENTRICULAR CHANGES ARE AFFECTED BY DIETARY SALT INTAKE IN PRIMARY ALDOSTERONISM

Abstract

Objective: Primary aldosteronism is associated with increased left ventricular mass independent of blood pressure levels. Previous studies suggest that elevated aldosterone causes cardiac damage only in the presence of an inappropriate salt status. We examined the relevance of dietary salt intake on cardiac changes in patients with primary aldosteronism before and after treatment. Design and Method: Sixty-five patients with tumoral or idiopathic primary aldosteronism were recruited at a University medical center and followed after either surgical (n = 30) or medical (n = 35) treatment. At baseline and 1 year after treatment, cardiac morphological and functional variables were measured by echocardiography together with duplicate 24-h urinary sodium collections. Results: At baseline, significantly greater left ventricular mass index was associated with increasing urinary sodium and plasma aldosterone levels above the median of the distribution. During follow-up, blood pressure and left ventricular mass index decreased significantly with only mild and nonsignificant changes in left ventricular geometry and functional properties. At the end of follow-up, decrease in left ventricular mass index was significantly greater in patients who had more than 10% reduction in urinary sodium excretion than in the remaining patients. Changes in left ventricular mass induced by both surgical and medical treatment were directly and independently related with changes in blood pressure and urinary sodium excretion observed at the end of follow-up (Figure). Conclusions: In conclusion, these findings strongly support the hypothesis that dietary salt intake has a crucial role in aldosterone-related left ventricular changes and could contribute to cardiac damage in patients with primary aldosteronism.