Adrenalectomy Improves Arterial Stiffness in Primary Aldosteronism

Abstract

BackgroundAldosterone has been shown to substantially contribute to the accumulation of different types of collagen fibers and growth factors in the arterial wall, which increase wall stiffness. We previously showed that arterial wall stiffness is increased in primary aldosteronism (PA) independently of concomitant hypertension. This study was aimed at assessing the effects of specific treatment of PA on the arterial stiffness.MethodsTwenty-nine patients with confirmed PA (15 with aldosterone-producing adenoma treated by unilateral laparoscopic adrenalectomy, 14 treated with spironolactone (mainly idiopathic aldosteronism) were investigated by Sphygmocor applanation tonometer (using measurement of carotid-femoral pulse wave velocity (PWV) and augmentation index (AI)) at the time of the diagnosis and then approximately 1 year after the specific treatment.ResultsThe office blood pressure (BP) decreased from 167 +/- 18/96 +/- 9 to 136 +/- 12/80 +/- 7 mm Hg after adrenalectomy (P = 0.001), and from 165 +/- 21/91 +/- 13 to 151 +/- 22/88 +/- 8 mm Hg (not significant (n.s.)) on spironolactone. The mean 24-h BP decreased from 150 +/- 18/93 +/- 11 mm Hg to 126 +/- 17/80 +/- 10 mm Hg after adrenalectomy (P < 0.01), and from 155 +/- 16/94 +/- 12 to 139 +/- 18/88 +/- 8 mm Hg (n.s.) on spironolactone. The PWV significantly decreased after surgery from 9.5 +/- 2.7 m/s to 7.6 +/- 2 m/s (P = 0.001), and the AI (recalculated for heart rate 75/min) decreased significantly from 27 +/- 10 to 19 +/- 9% (P < 0.01). On the other hand, we did not find significant change of arterial stiffness indices in patients treated with spironolactone (PWV: 9.3 +/- 1.6 m/s vs. 8.8 +/- 1.3 m/s (n.s.); AI: 25 +/- 9% vs. 25 +/- 8% (n.s.)).ConclusionsSurgical but not conservative treatment of PA led to a significant decrease of BP and arterial stiffness parameters.American Journal of Hypertension (2008). doi:10.1038/ajh.2008.243American Journal of Hypertension (2008); 21, 10, 1086-1092. doi 10.1038/ajh.2008.243.

Renal Resistive Index Predicts Postoperative Blood Pressure Outcome in Primary Aldosteronism

“…†Compared with 1 mo. by guest on May 11, 2018 http://hyper.ahajournals.org/ Downloaded from arterioles in our study). One reason for the lower EDV levels in the interlobar artery before surgery might be heightened vascular stiffness because of high levels of aldosterone.…”

“…One reason for the lower EDV levels in the interlobar artery before surgery might be heightened vascular stiffness because of high levels of aldosterone. It has been shown that adrenalectomy improves arterial stiffness in patients with PA. 18 In addition, because aldosterone constricts distal small arteries, such as glomerular afferent and efferent arterioles, 19,20 the lower EDV in the interlobar artery might be because of heightened downstream vascular resistance. We also observed that EDV decreased in the interlobar artery from 1 month to 12 months postoperatively, returning to the baseline level.…”

Primary Aldosteronism: Changing Definitions and New Concepts of Physiology and Pathophysiology Both Inside and Outside the Kidney

“…In a study reported by Tsuchiya et al (527), both unilateral adrenalectomy and spironolactone treatment led to improvements in endothelial function in patients with PA (which was worse than in essential hypertensives despite similar blood pressure levels on nonspecific antihypertensives). Strauch et al (504) reported unilateral adrenalectomy but not spironolactone to result in reduced arterial stiffness (measured as carotid-femoral pulse wave velocity and augmentation index) in PA patients studied ϳ1 yr following surgery or commencement of medical treatment. Catena et al (81) similarly found surgery but not spironolactone to result in significant reduction in left ventricular mass after one year.…”

SFE/SFHTA/AFCE consensus on primary aldosteronism, part 6: Adrenal surgery

“…Those with long-term followup suggested that spironolactone provided the same effect, but more slowly [25]. Likewise, pulse-wave velocity and carotid intima-media thickness, which are increased in PA, improved after surgery [26,27] and spironolactone again provided the same benefit, but more slowly [28].…”