CD3 ALDOSTERONISM, HEART AND VESSELS

Abstract

It has been documented that absolute aldosterone excess in patients with primary aldosteronism (PA) has been associated with higher risk of heart, vascular and kidney damage independent on blood pressure and resulting in increased total cardiovascular risk. Structural (left ventricular hypertrophy) and functional (diastolic dysfunction) changes of the heart have been documented in patients with PA. We have shown that patients with resistant hypertension and PA are characterized by higher prevalence of left ventricular hypertrophy than patients with resistant hypertension without PA. Moreover this relationship was influenced by coexistence of obstructive sleep apnoea, being related to the pattern of left ventricular hypertrophy. In patients with PA the mechanisms by which elevated aldosterone exerts its deleterious effect lead to functional and/or structural abnormalities of the blood vessel wall being more pronounced than in patients with essential hypertension. Studies performed so far documented that patients with PA as compared with patients with essential hypertension are characterized by hypertrophy and fibrosis of small resistance arteries evaluated ex vivo, increased intima media thickness and more pronounced aortic stiffness. Our preliminary results from the ongoing study showed also for the first time that patients with PA are characterized by hypertrophic vascular remodelling of retinal arterioles evaluated in vivo by scanning laser Doppler flowmetry. In summary, current evidence convincingly demonstrates that patients with PA are characterized by more pronounced damage of heart, small and large arteries and kidneys than those with essential hypertension. These findings correspond to the high cardiovascular risk of patients with PA.