Abstract
PurposeRecent studies have shown that the risk of cerebro- and cardiovascular events (CVEs) is higher in patients with primary aldosteronism (PA) than in those with essential hypertension (EH), and that silent brain infarction (SBI) is a risk factor and predictor of CVEs. Here, we evaluated the relationship between findings from laser speckle flowgraphy (LSFG), a recently introduced non-invasive means of measuring mean blur rate (MBR), an important biomarker of ocular blood flow, and the occurrence of SBI in patients with PA.Methods87 PA patients without symptomatic cerebral events (mean 55.1 ± 11.2 years old, 48 male and 39 female) were enrolled in this study. We measured MBR in the optic nerve head (ONH) with LSFG and checked the occurrence of SBI with magnetic resonance imaging. We examined three MBR waveform variables: skew, blowout score (BOS) and blowout time (BOT). We also recorded clinical findings, including age, blood pressure, and plasma aldosterone concentration.ResultsPA patients with SBI (15 of 87 patients; 17%) were significantly older and had significantly lower BOT in the capillary area of the ONH than the patients without SBI (P = 0.02 and P = 0.03, respectively). Multiple logistic regression analysis revealed that age and BOT were independent factors for the presence of SBI in PA patients (OR, 1.15, 95% CI 1.01–1.38; P = .03 and OR, 0.73, 95% CI 0.45–0.99; P = .04, respectively).ConclusionPA patients with SBI were older and had lower MBR BOT than those without SBI. Our analysis showed that age was a risk factor for SBI, and that BOT was a protective factor, in patients with PA. This suggests that BOT, a non-invasive and objective biomarker, may be a useful predictor of SBI and form part of future PA evaluations and clinical decision-making.
Highlights
Ocular Circulation and Silent Brain Infarction in Aldosteronism independent factors for the presence of silent brain infarction (SBI) in Primary aldosteronism (PA) patients (OR, 1.15, 95% CI 1.01–1.38; P = .03 and OR, 0.73, 95% CI 0.45–0.99; P = .04, respectively)
Our analysis showed that age was a risk factor for SBI, and that blowout time (BOT) was a protective factor, in patients with PA
This suggests that BOT, a non-invasive and objective biomarker, may be a useful predictor of SBI and form part of future PA evaluations and clinical decision-making
Summary
Primary aldosteronism (PA), known as primary hyperaldosteronism, is characterized by bilateral adrenal hyperplasia or aldosterone-producing adenomas causing overproduction of the mineralocorticoid hormone aldosterone, without excessive renin secretion.[1,2] PA patients are becoming more prevalent and account for up to 10% of cases of hypertension in selected populations, constituting the most frequent endocrinal cause of hypertension and a major problem worldwide.[3,4] Aldosterone causes an increase in sodium and potassium excretion in the renal tubules, leading to water retention and a subsequent increase in blood pressure.There are many reports showing that prolonged exposure to high aldosterone concentrations negatively affects cardiovascular tissues independently of blood pressure (BP).[5,6,7,8] Namely, a higher risk of cerebro- and cardiovascular events (CVEs) has been observed in PA patients than in those with essential hypertension (EH).[5,9,10] Silent brain infarctions (SBIs), despite not causing identifiable symptoms and often remaining unnoticed by patients, still cause damage to the brain and place the patient at increased risk for both transient ischemic attacks and major strokes.[11]. There are currently no reports on the clinical relationship between PA and SBI
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