The Evaluation of Atherosclerotic Makers after 1-Year Followed up on Patients with Primary Aldosteronism Treated By Mineralcorticoid Receptor Antagonists

Presentation Number: SUN 528
Date of Presentation: April 2nd, 2017

Takamasa Ichijo*, Yuka Kobayashi, Masanori Hasebe, Tomoko Yagi, Ayami Ueda, Kaoru Yamashita and Mariko Higa
Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan

Abstract

Primary aldosteronism (PA) is the most common endocrinological hypertension and its prevalence is approximately 10% of all patients with hypertension. It is known that the cardiovascular risk with PA is much higher than blood pressure matched essential hypertension. We treat those un-operated PA patients by the mineralcorticoid receptor antagonists (MRAs) according to the guideline, although the target value of plasma aldosterone concentration (PAC) and plasma renin activity (PRA) for anti-atherosclerotic effects are still unclear.

Thus, in this study, we evaluated the atherosclerotic parameters of 1-year-followed up patients with non-operated primary aldosteronism (PA) treated by the MRAs in our hospital. We employed the intima-media thickness (IMT) by carotid artery ultrasonography, brachial-ankle pulse wave velocity (baPWV), and ankle brachial pressure index (ABI) as the parameters of atherosclerosis. We measured all those parameters and PAC and PRA after 1-year treatment by MRAs in 177 patients including 64 males and 113 females with age of 56.7±12.4 years old, and we defined those patients with both aldosterone-renin ratio (ARR) <20 and PRA >1.0 ng/ml/hr as the controlled group and the others as the uncontrolled group. We compared those parameters between 2 groups, to clear out MRAs anti-atherosclerotic effects and an idea of target value of PAC and PRA.

In result, no significant difference was seen in the blood pressure, IMT, baPWV nor ABI between 2 groups after 1-year treatment. The changing values from baseline also showed no difference between 2 groups except the baPWV. The only changing value from baseline of baPWV showed significant improvement in controlled group than uncontrolled group (-126.7±302.2 vs. -48.2±248.2, p=0.0145), respectively.

One possibility of the reason only baPWV showed significant improvement is that IMT and ABI represent the arterial wall thickness and stenosis, comparatively baPWV represents the arterial stiffness. The treatment term, 1-year, by MRAs might be too short to improve for the arterial thickness or stenosis, but enough for the improvement of stiffness.

In conclusion, when non-operated PA is well controlled by MRAs, even only 1-year treatment might be able to show significant improvement and prevention of atherosclerosis.

 

Nothing to Disclose: TI, YK, MH, TY, AU, KY, MH