CLINICAL RESEARCH: PRIMARY ALDOSTERONISM
Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism
Paul Milliez, MD*,
Xavier Girerd, MD, PhD ,
Pierre-François Plouin, MD ,
Jacques Blacher, MD, PhD ,
Michel E. Safar, MD,* and
Jean-Jacques Mourad, MD, PhD||
* Department of Cardiology, Lariboisière Hospital, Paris, France
Department of Endocrinology, Pitié-Salpêtrière Hospital, Paris, France
Department of Hypertension, Georges Pompidou Hospital, Paris, France
Diagnosis Center, Hôtel-Dieu, Paris, France
|| Department of Internal Medicine, Avicenne Hospital, Bobigny, France.
Manuscript received March 27, 2004;
revised manuscript received December 20, 2004,
accepted January 4, 2005.
* Reprint requests and correspondence: Dr. Michel Safar, Centre de Diagnostic, Hôtel-Dieu, 1, Place du Parvis Notre-Dame, 75181 Paris Cedex 04, France. (Email: michel.safar{at}htd.aphp.fr).
OBJECTIVES: The aim of this report was to show that the rate of cardiovascular events is increased in patients with either subtype of primary aldosteronism (PA).
BACKGROUND: Primary aldosteronism involves hypertension (HTN), hypokalemia, and low plasma renin. The two major PA subtypes are unilateral aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia.
METHODS: During a three-year period, the diagnosis of PA was made in 124 of 5,500 patients referred for comprehensive evaluation and management. Adenomas were diagnosed in 65 patients and idiopathic hyperaldosteronism in 59 patients. During the same period, clinical characteristics and cardiovascular events of this group were compared with those of 465 patients with essential hypertension (EHT) randomly matched for age, gender, and systolic and diastolic blood pressure.
RESULTS: A history of stroke was found in 12.9% of patients with PA and 3.4% of patients with EHT (odds ratio [OR] = 4.2; 95% confidence interval [CI] 2.0 to 8.6]). Non-fatal myocardial infarction was diagnosed in 4.0% of patients with PA and in 0.6% of patients with EHT (OR = 6.5; 95% CI 1.5 to 27.4). A history of atrial fibrillation was diagnosed in 7.3% of patients with PA and 0.6% of patients with EHT (OR = 12.1; 95% CI 3.2 to 45.2). The occurrence of cardiovascular complications was comparable in both subtypes of PA.
CONCLUSIONS: Patients presenting with PA experienced more cardiovascular events than did EHT patients independent of blood pressure. The presence of PA should be detected, not only to determine the cause of HTN, but also to prevent such complications.
|
Abbreviations and Acronyms
| | AF = atrial fibrillation | | APA = aldosterone-producing adenoma | | ARR = aldosterone to renin ratio | | BP = blood pressure | | CI = confidence interval | | CT = computed tomographic | | ECG = electrocardiogram/electrocardiographic | | EHT = essential hypertension | | HTN = hypertension | | LVH = left ventricular hypertrophy | | MI = myocardial infarction | | OR = odds ratio | | PA = primary aldosteronism |
|
Related Article
-
Should we consider aldosterone as the primary screening target for preventing cardiovascular events?
- Gary S. Francis and W.H. Wilson Tang
J. Am. Coll. Cardiol. 2005 45: 1249-1250.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
E M Freel, I K Tsorlalis, J D Lewsey, R Latini, A P Maggioni, S Solomon, B Pitt, J M C Connell, and J J V McMurray
Aldosterone status associated with insulin resistance in patients with heart failure--data from the ALOFT study
Heart,
December 1, 2009;
95(23):
1920 - 1924.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. S. Mihailidou, T. Y. Loan Le, M. Mardini, and J. W. Funder
Glucocorticoids Activate Cardiac Mineralocorticoid Receptors During Experimental Myocardial Infarction
Hypertension,
December 1, 2009;
54(6):
1306 - 1312.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Stowasser
Update in Primary Aldosteronism
J. Clin. Endocrinol. Metab.,
October 1, 2009;
94(10):
3623 - 3630.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R.-F. Yen, V.-C. Wu, K.-L. Liu, M.-F. Cheng, Y.-W. Wu, S.-C. Chueh, W.-C. Lin, K.-D. Wu, K.-Y. Tzen, C.-C. Lu, et al.
131I-6{beta}-Iodomethyl-19-Norcholesterol SPECT/CT for Primary Aldosteronism Patients with Inconclusive Adrenal Venous Sampling and CT Results
J. Nucl. Med.,
October 1, 2009;
50(10):
1631 - 1637.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Maturana, S. Lenglet, M. Python, S. Kuroda, and M. F. Rossier
Role of the T-Type Calcium Channel CaV3.2 in the Chronotropic Action of Corticosteroids in Isolated Rat Ventricular Myocytes
Endocrinology,
August 1, 2009;
150(8):
3726 - 3734.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. W. Funder
The Off-Target Effects of Torcetrapib
Endocrinology,
May 1, 2009;
150(5):
2024 - 2026.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Born-Frontsberg, M. Reincke, L. C. Rump, S. Hahner, S. Diederich, R. Lorenz, B. Allolio, J. Seufert, C. Schirpenbach, F. Beuschlein, et al.
Cardiovascular and Cerebrovascular Comorbidities of Hypokalemic and Normokalemic Primary Aldosteronism: Results of the German Conn's Registry
J. Clin. Endocrinol. Metab.,
April 1, 2009;
94(4):
1125 - 1130.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Matrozova, O. Steichen, L. Amar, S. Zacharieva, X. Jeunemaitre, and P.-F. Plouin
Fasting Plasma Glucose and Serum Lipids in Patients With Primary Aldosteronism: A Controlled Cross-Sectional Study
Hypertension,
April 1, 2009;
53(4):
605 - 610.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Lopez-Andres, C. Inigo, I. Gallego, J. Diez, and M. A. Fortuno
Aldosterone Induces Cardiotrophin-1 Expression in HL-1 Adult Cardiomyocytes
Endocrinology,
October 1, 2008;
149(10):
4970 - 4978.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. F. Rossier, S. Lenglet, L. Vetterli, M. Python, and A. Maturana
Corticosteroids and Redox Potential Modulate Spontaneous Contractions in Isolated Rat Ventricular Cardiomyocytes
Hypertension,
October 1, 2008;
52(4):
721 - 728.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Karagiannis, K. Tziomalos, A. I Kakafika, V. G Athyros, F. Harsoulis, and D. P Mikhailidis
Medical treatment as an alternative to adrenalectomy in patients with aldosterone-producing adenomas
Endocr. Relat. Cancer,
September 1, 2008;
15(3):
693 - 700.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. W. Funder, R. M. Carey, C. Fardella, C. E. Gomez-Sanchez, F. Mantero, M. Stowasser, W. F. Young Jr., and V. M. Montori
Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline
J. Clin. Endocrinol. Metab.,
September 1, 2008;
93(9):
3266 - 3281.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. L. Muiesan, M. Salvetti, A. Paini, C. Agabiti-Rosei, C. Monteduro, G. Galbassini, E. Belotti, C. Aggiusti, D. Rizzoni, M. Castellano, et al.
Inappropriate Left Ventricular Mass in Patients With Primary Aldosteronism
Hypertension,
September 1, 2008;
52(3):
529 - 534.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Mulatero
A New Form of Hereditary Primary Aldosteronism: Familial Hyperaldosteronism Type III
J. Clin. Endocrinol. Metab.,
August 1, 2008;
93(8):
2972 - 2974.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. P. Rossi, A. Belfiore, G. Bernini, B. Fabris, G. Caridi, C. Ferri, G. Giacchetti, C. Letizia, M. Maccario, M. Mannelli, et al.
Body Mass Index Predicts Plasma Aldosterone Concentrations in Overweight-Obese Primary Hypertensive Patients
J. Clin. Endocrinol. Metab.,
July 1, 2008;
93(7):
2566 - 2571.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B Rayner
Primary aldosteronism and aldosterone-associated hypertension
J. Clin. Pathol.,
July 1, 2008;
61(7):
825 - 831.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. L. Serra and M. Bendersky
Review: Atrial fibrillation and renin-angiotensin system
Therapeutic Advances in Cardiovascular Disease,
June 1, 2008;
2(3):
215 - 223.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. W. Krug and M. Ehrhart-Bornstein
Aldosterone and Metabolic Syndrome: Is Increased Aldosterone in Metabolic Syndrome Patients an Additional Risk Factor?
Hypertension,
May 1, 2008;
51(5):
1252 - 1258.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. C. Connell, S. M. MacKenzie, E. M. Freel, R. Fraser, and E. Davies
A Lifetime of Aldosterone Excess: Long-Term Consequences of Altered Regulation of Aldosterone Production for Cardiovascular Function
Endocr. Rev.,
April 1, 2008;
29(2):
133 - 154.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Mulatero, C. Bertello, D. Rossato, G. Mengozzi, A. Milan, C. Garrone, G. Giraudo, G. Passarino, D. Garabello, A. Verhovez, et al.
Roles of Clinical Criteria, Computed Tomography Scan, and Adrenal Vein Sampling in Differential Diagnosis of Primary Aldosteronism Subtypes
J. Clin. Endocrinol. Metab.,
April 1, 2008;
93(4):
1366 - 1371.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Bauersachs and D. Fraccarollo
More NO-No More ROS: Combined Selective Mineralocorticoid Receptor Blockade and Angiotensin-Converting Enzyme Inhibition for Vascular Protection
Hypertension,
March 1, 2008;
51(3):
624 - 625.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Burstein and S. Nattel
Atrial Fibrosis: Mechanisms and Clinical Relevance in Atrial Fibrillation
J. Am. Coll. Cardiol.,
February 26, 2008;
51(8):
802 - 809.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. J. Brown
Aldosterone and Vascular Inflammation
Hypertension,
February 1, 2008;
51(2):
161 - 167.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Catena, G. Colussi, E. Nadalini, A. Chiuch, S. Baroselli, R. Lapenna, and L. A. Sechi
Cardiovascular Outcomes in Patients With Primary Aldosteronism After Treatment
Arch Intern Med,
January 14, 2008;
168(1):
80 - 85.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Catena, G. Colussi, R. Lapenna, E. Nadalini, A. Chiuch, P. Gianfagna, and L. A. Sechi
Long-Term Cardiac Effects of Adrenalectomy or Mineralocorticoid Antagonists in Patients With Primary Aldosteronism
Hypertension,
November 1, 2007;
50(5):
911 - 918.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. S. Rigsby, A. E. Burch, S. Ogbi, D. M. Pollock, and A. M. Dorrance
Intact female stroke-prone hypertensive rats lack responsiveness to mineralocorticoid receptor antagonists
Am J Physiol Regulatory Integrative Comp Physiol,
October 1, 2007;
293(4):
R1754 - R1763.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. M. Kaplan and D. A. Calhoun
Is There an Unrecognized Epidemic of Primary Aldosteronism? (Con)
Hypertension,
September 1, 2007;
50(3):
454 - 458.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. P. Rossi, A. Belfiore, G. Bernini, G. Desideri, B. Fabris, C. Ferri, G. Giacchetti, C. Letizia, M. Maccario, F. Mallamaci, et al.
Comparison of the Captopril and the Saline Infusion Test for Excluding Aldosterone-Producing Adenoma
Hypertension,
August 1, 2007;
50(2):
424 - 431.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. A. Calhoun
Aldosterone and Cardiovascular Disease: Smoke and Fire
Circulation,
December 12, 2006;
114(24):
2572 - 2574.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. P. Rossi, G. Bernini, G. Desideri, B. Fabris, C. Ferri, G. Giacchetti, C. Letizia, M. Maccario, M. Mannelli, M.-J. Matterello, et al.
Renal Damage in Primary Aldosteronism: Results of the PAPY Study
Hypertension,
August 1, 2006;
48(2):
232 - 238.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Mulatero, A. Milan, F. Fallo, G. Regolisti, F. Pizzolo, C. Fardella, L. Mosso, L. Marafetti, F. Veglio, and M. Maccario
Comparison of Confirmatory Tests for the Diagnosis of Primary Aldosteronism
J. Clin. Endocrinol. Metab.,
July 1, 2006;
91(7):
2618 - 2623.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Nagata, M. Takahashi, K. Sawai, T. Tagami, T. Usui, A. Shimatsu, Y. Hirata, and M. Naruse
Molecular Mechanism of the Inhibitory Effect of Aldosterone on Endothelial NO Synthase Activity
Hypertension,
July 1, 2006;
48(1):
165 - 171.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Nehme, N. Mercier, C. Labat, A. Benetos, M. E Safar, C. Delcayre, and P. Lacolley
Differences Between Cardiac and Arterial Fibrosis and Stiffness in Aldosterone-Salt Rats: Effect of Eplerenone
Journal of Renin-Angiotensin-Aldosterone System,
March 1, 2006;
7(1):
31 - 39.
[Abstract]
[PDF]
|
|
|
|
|
|
|
F. Fallo, F. Veglio, C. Bertello, N. Sonino, P. Della Mea, M. Ermani, F. Rabbia, G. Federspil, and P. Mulatero
Prevalence and Characteristics of the Metabolic Syndrome in Primary Aldosteronism
J. Clin. Endocrinol. Metab.,
February 1, 2006;
91(2):
454 - 459.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P.F. Bodary, C. Sambaziotis, K.J. Wickenheiser, S. Rajagopalan, B. Pitt, and D.T. Eitzman
Aldosterone Promotes Thrombosis Formation After Arterial Injury in Mice
Arterioscler Thromb Vasc Biol,
January 1, 2006;
26(1):
233 - 233.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Milliez, N. DeAngelis, C. Rucker-Martin, A. Leenhardt, E. Vicaut, E. Robidel, P. Beaufils, C. Delcayre, and S. N. Hatem
Spironolactone reduces fibrosis of dilated atria during heart failure in rats with myocardial infarction
Eur. Heart J.,
October 2, 2005;
26(20):
2193 - 2199.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Nattel
Aldosterone antagonism and atrial fibrillation: time for clinical assessment?
Eur. Heart J.,
October 2, 2005;
26(20):
2079 - 2080.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. S. Francis and W.H. W. Tang
Should we consider aldosterone as the primary screening target for preventing cardiovascular events?
J. Am. Coll. Cardiol.,
April 19, 2005;
45(8):
1249 - 1250.
[Full Text]
[PDF]
|
|
|
|
