Twenty-four hour urine aldosterone level predicts left ventricular hypertrophy in patients with primary aldosteronism and essential hypertension

Abstract

Objectives: Primary aldosteronism (PA) is associated with inappropriate left ventricular hypertrophy (LVH) in relation to a given gender and body size. Currently, there is no ideal parameter to predict the presence of LVH or inappropriate LVH in patients with primary aldosteronism. We investigate the performance of 24 hour urinary aldosterone level, plasma renin activity and aldosterone-to-renin ratio on this task. Materials and methods: We performed echocardiography in 106 patients with primary aldosteronism and 31 subjects with essential hypertension (EH) in a tertiary teaching hospital. Plasma renin activity, aldosterone concentration and 24-hour urinary aldosterone level were measured. In order to identify LVH, we compared four parameters: 24-hour urinary aldosterone, plasma aldosterone concentration, plasma renin activity and plasma aldosterone-to-renin ratio urinary aldosterone. Results: In a correlation study of both groups, only 24-hour urinary aldosterone correlated with left ventricular mass index (LVMI) and additional LVMI among the four parameters. The multivariate analysis revealed that the urinary aldosterone level was an independent predictor for LVMI and additional LVMI. The receiver operating characteristic analysis to assess the ability of urinary aldosterone, plasma aldosterone concentration and plasma aldosterone-to-renin ratio to identify the presence of LVH (ROC AUC=0.701, 0.568, 0.656, respectively) and the presence of inappropriate LV mass index (defined as: measured LVMI to predicted LVMI ratio > 135%) (ROC area under curve = 0.61, 0.43, 0.493, respectively) revealed the better performance of 24-hour urinary aldosterone in the PA group. The same phenomenon was also noted in the EH group. Conclusion: In conclusion, 24-hour urinary aldosterone level performed better than plasma aldosterone or aldosterone-to-renin ratio to predict the presence of LVH and inappropriate LVMI in patients with primary aldosteronism.