Abstract
Objective. Primary aldosteronism (PA) is associated with inappropriate left ventricular hypertrophy (LVH) in relation to a given gender and body size. There is no ideal parameter to predict the presence of LVH or inappropriate LVH in patients with PA. We investigate the performance of 24-hour urinary aldosterone level, plasma renin activity and aldosterone-to-renin ratio on this task. Methods. We performed echocardiography in 106 patients with PA 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. Results. Only 24-hour urinary aldosterone was correlated with left ventricular mass index (LVMI) and excess LVMI among these parameters. The multivariate analysis revealed the urinary aldosterone level as an independent predictor for LVMI and excess LVMI. Analyzing 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, resp.) and the presence of inappropriate LV mass index (defined as measured LVMI in predicting LVMI ratio >135%) (ROC area under curve = 0.61, 0.43, 0.493, resp.) revealed the better performance of 24-hour urinary aldosterone. Conclusions. In conclusion, 24-hour urinary aldosterone level performed better to predict the presence of LVH and inappropriate LVMI in patients with PA.
Highlights
Primary aldosteronism (PA), characterized by an inappropriate production of aldosterone, can be found in 5–13% of patients with hypertension [1, 2]
In patients with essential hypertension, the presence of inappropriate left ventricular mass (LVM) for a given workload is associated with a higher prevalence of low LV systolic contractility and abnormal relaxation, which suggests a higher risk of transition from compensatory Left ventricular hypertrophy (LVH) into symptomatic heart failure [8]
There was a trend for higher diastolic blood pressure in patients with PA compared with those in the essential hypertension group
Summary
Primary aldosteronism (PA), characterized by an inappropriate production of aldosterone, can be found in 5–13% of patients with hypertension [1, 2]. Patients with PA have an inappropriate degree of left ventricular concentric remodeling compared with patients with essential hypertension of a similar level of blood pressure [4,5,6]. Left ventricular hypertrophy (LVH) is a compensatory response to the increased afterload. The left ventricular mass (LVM) may increase disproportionately to the hemodynamic load in patients with PA [4]. In patients with essential hypertension, the presence of inappropriate LVM for a given workload is associated with a higher prevalence of low LV systolic contractility and abnormal relaxation, which suggests a higher risk of transition from compensatory LVH into symptomatic heart failure [8]. The long-term effect of inappropriate LVM in patients with PA is still unknown
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