(Hypertension. 1996;27:1039-1045.)
© 1996 American Heart Association, Inc.
Articles |
Changes in Left Ventricular Anatomy and Function in Hypertension and Primary Aldosteronism
From the Department of Clinical and Experimental Medicine, University of Padua Medical School and Azienda Ospedaliera di Padova (Italy).
Correspondence to Gian Paolo Rossi, MD, FACC, Dipartimento di Medicina Clinica e Sperimentale, Policlinico Universitario, via Giustiniani, 2, 35126 Padova, Italy.
Abstract We investigated the effects on the heart of
hypertension due to the excess of aldosterone and
suppression of the renin-angiotensin system caused by
primary aldosteronism with M-mode echocardiography
and transmitral Doppler flow velocity measurements. We studied 34
consecutive patients with primary aldosteronism and 34 with essential
hypertension individually matched for age, gender, race, body mass
index, blood pressure values, and duration of hypertension. The groups
were similar in age, body mass index, blood pressure, and duration of
hypertension. However, lower serum potassium levels (3.5±0.6 versus
4.1±0.2 mmol/L, P<.0001) and plasma renin activity
(0.53±0.45 versus 1.82±1.59 ng Ang
I·mL-1·h-1,
P<.0001) and higher plasma aldosterone levels
(1107±774 versus 206±99 pmol/L, P<.0001), left
ventricular wall thickness, and left
ventricular mass index (112±4.7 versus 98±3.7
g/m2, P=.029) were found in patients with
primary aldosteronism compared with those with essential hypertension.
Similarly, the PQ interval was longer (173±20 versus 141±14
milliseconds, P<.001) in primary aldosteronism than in
essential hypertension patients. Significantly more primary
aldosteronism than essential hypertension patients had left
ventricular hypertrophy or left
ventricular concentric remodeling (50% versus 15%,
2=11.97, P=.007). Both the E wave flow
velocity integral (1063±65 versus 1323±78, P=.013) and the
E/A integral ratio (0.91±0.05 versus 1.25±0.08, P<.001)
were lower, and atrial contribution to left ventricular
filling was higher (53.3±1.5% versus 45.5±1.3%, P<.001)
in patients with primary aldosteronism compared with essential
hypertension patients. After 1 year of follow-up, highly
significant decreases of left ventricular wall thickness
and mass were observed in patients treated with surgical excision of an
aldosterone-producing tumor, but not in those treated
with medical therapy. Thus, in patients with primary aldosteronism, the
excess aldosterone with suppression of the
renin-angiotensin system is associated with both
increased left ventricular mass and significant changes of
left ventricular diastolic filling. The former
changes appear to be reversible on removal of the cause of excessive
aldosterone production.
Key Words: hypertension, essential • aldosterone • hypertrophy • myocardium • echocardiography • fibrosis
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