Comparisons of microvascular and macrovascular changes in aldosteronism-related hypertension and essential hypertension

Varano, Monica; Iacono, Pierluigi; Tedeschi, Massimiliano; Letizia, Claudio; Curione, Mario; Savoriti, Claudio; Baiocco, Erika; Zinnamosca, Laura; Marinelli, C.; Boccassini, Barbara; Parravano, Mariacristina

doi:10.1038/s41598-017-02622-2

Cited by 12 publications

(10 citation statements)

References 66 publications

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“…All patients and controls were imaged by a Retinal Vessel Analyzer (RVA) by positioning the subject in front of a non-midriatic camera (TopconTRC-NV2000) to obtain a retinographic image (45°). The images were then processed by IMEDOS software measuring the caliber of vessels emerging from the optic disc, as previously described 37 . In particular, the RVA produces continuous and automated analysis of the vessels combined with correction for small eye movements.…”

Section: Methodsmentioning

confidence: 99%

Retinal micro-vascular and aortic macro-vascular changes in postmenopausal women with primary hyperparathyroidism

Pepe

Cipriani

Tedeschi

et al. 2018

Sci Rep

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Aim of the study was to evaluate the micro and macro-vascular changes in patients with primary hyperparathyroidism (PHPT) compared to controls. 30 postmenopausal PHPT women (15 hypertensive and 15 normotensive) and 30 normotensive controls underwent biochemical evaluation of mineral metabolism and measurements of arterial stiffness by 24 hour ambulatory blood pressure monitoring. Retinal microcirculation was imaged by a Retinal Vessel Analyzer. PHPT patients also underwent bone mineral density measurements and kidney ultrasound. PHPT patients had higher mean calcium and parathyroid hormone values compared to controls. Evaluating macro-vascular compartment, we found higher values of 24 hours-systolic, diastolic blood pressure, aortic pulse wave velocity (aPWV) and aortic augmentation index (Aix) in hypertensive PHPT, but not in normotensive PHPT compared to controls. The eye examination showed narrowing arterial and venular diameters of retinal vessels in both hypertensive and normotensive PHPT compared to controls. In hypertensive PHPT, 24 hours systolic blood pressure was associated only with parathyroid hormone (PTH) levels (beta = 0.36, p = 0.04). aPWV was associated with retinal diameter (beta = −0.69, p = 0.003), but not with PTH. Retinal artery diameter was associated with PTH (beta = −0.6, p = 0.008). In the normotensive PHPT, only PTH was associated with retinal artery diameter (beta = −0.60, p = 0.01) and aortic AIx (beta = 0.65, p = 0.02). In conclusion, we found macro-vascular impairment in PHPT and that micro-vascular impairment is negatively associated with PTH, regardless of hypertension in PHPT.

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Section: Methodsmentioning

confidence: 99%

Retinal micro-vascular and aortic macro-vascular changes in postmenopausal women with primary hyperparathyroidism

Pepe

Cipriani

Tedeschi

et al. 2018

Sci Rep

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“…Nongenetic forms of HA are often treated surgically but chronic oral mineralocorticoid receptor (MR) antagonism, generally with spironolactone, has also been used to lower BP . It is believed that the end‐organ damage profile in patients with HA is more severe than essential hypertension, including increased prevalence of cerebral hemorrhage, myocardial infarction, left ventricular hypertrophy, cardiac fibrosis, increased arterial stiffness, microalbuminuria, and microcirculatory wall‐to‐lumen ratio . Attribution of HA‐associated target organ damage, however, is universally confounded by the effects of aging as well as the duration and degree of BP elevation (BP burden) .…”

Section: Introductionmentioning

confidence: 99%

Long‐term BP control and vascular health in patients with hyperaldosteronism treated with low‐dose, amiloride‐based therapy

Izzo

Hong

Hussain

et al. 2019

J of Clinical Hypertension

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Whether aldosterone itself contributes directly to macro‐ or microcirculatory disease in man or to adverse cardiovascular outcomes is not fully known. We report our long‐term single‐practice experience in 5 patients with chronic hyperaldosteronism (HA, including 3 with glucocorticoid remediable aldosteronism, GRA) treated with low‐dose amiloride (a specific epithelial sodium channel [ENaC] blocker) 5‐10 (mean 7) mg daily for 14‐28 (mean 20) years. Except for 1 GRA diagnosed in infancy, all had severe resistant hypertension. In each case, BP was normal or near‐normal within 1‐4 weeks after starting amiloride and office BP’s were well controlled for 20 years thereafter. Vascular studies and 24‐hour ambulatory BP monitoring with pulse wave analysis (cardiac output, vascular resistance, augmentation index, and reflection magnitude) were assessed after a mean of 18 years as were regional pulse wave velocities, pulse stiffening ratio, ankle‐brachial index, serum creatinine, estimated glomerular filtration rate, and spot urinary albumin:creatinine ratio. All indicators were completely normal in all patients after 18 years of amiloride, and none had a cardiovascular event during the 20‐year mean follow‐up. We conclude that long‐term ENaC blockade can normalize BP and protect macro‐ and microvascular function in patients with HA. This suggests that (a) any vasculopathic effects of aldosterone are mediated via ENaC, not MR activation itself, and are fully preventable or reversible with ENaC blockade or (b) aldosterone may not play a major BP‐independent role in human macro‐ and microcirculatory diseases. These and other widely divergent results in the literature underscore the need for additional studies regarding aldosterone, ENaC, and vascular disease.

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“…The question of the effect of aldosterone on intrarenal hemodynamics in patients with primary aldosteronism is important. Changes in the state of intrarenal hemodynamics are due not only to the effect of arterial pressure in this category of patients, but also directly to aldosterone [4,5,6].…”

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Primary Aldosteronism: The Results of the Treatment According to the Data of Renal Arteries Duplex Scanning

Zubryk

2019

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In the structure of arterial hypertension, primary aldosteronism (РА) ranges from 5 to 15%. Changes in intrarenal hemodynamics are due to both high blood pressure and direct aldosterone level. The purpose of the study was to analyze the results of PA treatment according to ultrasound doppler scanning of renal arteries. In general, 55 patients with PA were treated. Renal arteries duplex scanning before and after the treatment was performed in 20 patients. During treatment, the normalization of Vps, Ved, S/D, PI, PI, AT, TAMX indices was recorded in patients. The RI of the interlobar arteries slightly increased, however, it remained within the reference range. The reduction of aldosterone levels led to increase of TAMX index at the level of the renal artery trunk, S/D, RI and decrease in AT at the level of the segmental arteries, as well as increase of Ved and S/D at the level of the interlobar arteries.

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Comparisons of microvascular and macrovascular changes in aldosteronism-related hypertension and essential hypertension

Cited by 12 publications

References 66 publications

Retinal micro-vascular and aortic macro-vascular changes in postmenopausal women with primary hyperparathyroidism

Retinal micro-vascular and aortic macro-vascular changes in postmenopausal women with primary hyperparathyroidism

Long‐term BP control and vascular health in patients with hyperaldosteronism treated with low‐dose, amiloride‐based therapy

Primary Aldosteronism: The Results of the Treatment According to the Data of Renal Arteries Duplex Scanning

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