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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

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