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(Hypertension. 2006;48:232.)
© 2006 American Heart Association, Inc.

Original Articles

Renal Damage in Primary Aldosteronism

Results of the PAPY Study

Gian Paolo Rossi; Giampaolo Bernini; Giovambattista Desideri; Bruno Fabris; Claudio Ferri; Gilberta Giacchetti; Claudio Letizia; Mauro Maccario; Massimo Mannelli; Mee-Jung Matterello; Domenico Montemurro; Gaetana Palumbo; Damiano Rizzoni; Ermanno Rossi; Achille Cesare Pessina; Franco Mantero for the PAPY Study Participants

From the Department of Clinical and Experimental Medicine, Clinica Medica 4, University Hospital, Padova, Italy.

Correspondence to Gian Paolo Rossi, DMCS Clinica Medica 4, University Hospital, via Giustiniani, 2, 35126 Padova, Italy. E-mail gianpaolo.rossi{at}unipd.it

Primary aldosteronism (PA) has been associated with cardiovascular hypertrophy and fibrosis, in part independent of the blood pressure level, but deleterious effects on the kidneys are less clear. Likewise, it remains unknown if the kidney can be diversely involved in PA caused by aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). Hence, in the Primary Aldosteronism Prevalence in Italy (PAPY) Study, a prospective survey of newly diagnosed consecutive patients referred to hypertension centers nationwide, we sought signs of renal damage in patients with PA and in comparable patients with primary hypertension (PH). Patients (n=1180) underwent a predefined screening protocol followed by tests for confirming PA and identifying the underlying adrenocortical pathology. Renal damage was assessed by 24-hour urine albumin excretion (UAE) rate and glomerular filtration rate (GFR). UAE rate was measured in 490 patients; all had a normal GFR. Of them, 31 (6.4%) had APA, 33 (6.7%) had IHA, and the rest (86.9%) had PH. UAE rate was predicted (P<0.001) by body mass index, age, urinary Na⁺ excretion, serum K⁺, and mean blood pressure. Covariate-adjusted UAE rate was significantly higher in APA and IHA than in PH patients; there were more patients with microalbuminuria in the APA and IHA than in the PH group (P=0.007). Among the hypertensive patients with a preserved GFR, those with APA or IHA have a higher UAE rate than comparable PH patients. Thus, hypertension because of excess autonomous aldosterone secretion features an early and more prominent renal damage than PH.

Key Words: hypertension, endocrine • aldosterone • mineralocorticoids • kidney • hypertrophy • adrenal gland

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Aldosterone, Dietary Salt, and Renal Disease

Eduardo Pimenta and David A. Calhoun
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