Endocrine Abstracts

Introduction: Primary aldosteronism (PA) is commonly identified as the main cause of secondary hypertension. It is becoming increasingly wide-spread, affecting between 1 and 30% of people suffering from hypertension. A prolonged exposure to high aldosterone concentrations has a deleterious effect on cardiovascular tissues and is associated with target organ damage, independently of blood pressure, so a higher risk of cardiovascular events has been reported in patients with primary aldosteronism,

Aim: The aim of this study was to evaluate the prevalence of cardiovascular and cerebrovascular events in patients with PA.

Patients and methods: Retrospective and descriptive study concerning 40 patients with PA, collected in the endocrinology department of the Hedi Chaker University Hospital of Sfax, over the period of 10 years from January 2010 to December 2022.

Results: The average age of our patients was 55.4 years. Fourteen patients had cardiovascular disease consisting of electrical left ventricular hypertrophy and/or hypertrophic cardiomyopathy on transthoracic echocardiogram and/or coronary artery disease. Four patients had cerebrovascular ischemic stroke. Analytical study showed that there was no significant statistical difference between plasma aldosterone concentration (PAC) in patients with and without cardiovascular disease (median PAC=226 pg/ml vs 199 pg/ml; P=0.856). Similarly, the PAC was higher in patients with cerebrovascular disease but the difference was not significant (median PA: 337 pg/ml vs 207 pg/ml; P=0.223). Twelve out of 40 patients (30%) with cardio and/or cerebrovascular disease had PAC above 200 pg/ml. The evolution of the cardiovascular risk after specific treatment of PA was not carried out in our study.

Conclusion: In addition to the classic role of aldosterone, which acts via the reabsorption of water and sodium in the kidney to induce volume expansion, several studies have shown that aldosterone has direct effects on the vascular system, even in the absence of hypertension. A recent meta-analysis of 31 studies demonstrated that patients with PA had an increased risk of stroke, coronary heart disease and heart failure compared with essential hypertension.

Reference: 1. Monticone S, D’Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. janv 2018;6(1):41-50.