Risk reductions of arteriosclerosis by normalization of hyperaldosteronism state. -Evaluation with the use of both intima-media thickness (IMT) of carotid artery and biochemical markers-

Presentation Number: SAT-57
Date of Presentation: June 15th, 2013

Kazumi Iino*1, Yutaka Oki2, Etsuko Hamada3, Miho Yamashita3, Kosuke Yogo1, Shoko Shibata3, Toshihiro Ohishi1, Keisuke Kakizawa1 and Masato Maekawa3
1Hamamatsu Univ Sch of Med, Hamamatsu, Japan, 2Hamamatsu Univ Schl of Med, Hamamatsu, Shizuoka, Japan, 3Hamamatsu Univ Sch of Medicine, Hamamatsu, Japan

Abstract

[Background] Several reports have shown that severe hypertension in primary aldosteronism (PA), which is often resistant to plural antihypertensive medicines, may carry higher risk of arteriosclerosis in comparison with that of essential hypertension (E-HT). Previously we reported that IMT levels tended to be higher in PA than in E-HT, and hyperaldosteronism might be one of independent risk factors of arteriosclerosis or cardiovascular disease. [Subjects/Method] PA patients (n=145) and background (except the age)-matched E-HT patients (n=37; f/m=17/22) were entered to this study. All of the PA patients were diagnosed as Aldosterone Producing Adenoma (APA) (n=63; f/m=27/36) or Idiopathic hyperaldosteronism (IHA) (n=82; f/m=53/29) based on their data of adrenal venous sampling. They underwent carotid ultrasonography and their maximum IMT was measured. Risk reductions 12 month after PA treatment were examined with the use of IMT (in 25 APA and 30 IHA) and biochemical markers including high-sensitivity C-reactive protein (HS-CRP), nitrotyrosine and adiponectin (in 4 APA and 7 IHA). [Result] IMT in PA was 1.00±0.42 mm, which was evidently thicker than that of age-matched normal controls. While there was a significant difference in age, an unequivocal contributing factor of IMT, between PA and E-HT (54.14±10.6 and 58.21±7.93 respectively), no difference was recognized between their IMTs (E-HT; 1.05±0.34mm). Significant improvement of IMT after control of hyperadosteronism was observed in both APA (1.00±0.92 vs. 0.94±0.23mm) and IHA (0.95±0.31 vs. 0.88±0.23mm). The apparent change of the three biomarkers could not be identified because of the small number examination. [Discussion] From our results, it can be concluded that, with the same degree of blood pressure, PA tends to develop severe IMT thickness, and that hyperaldosteronism may be one of independent risk factors of arteriosclerosis. We also demonstrated that the proper control of hyperaldosteronism state makes a contribution to the risk reduction in this study. Based on the two possible mechanisms of the arteriosclerosis, one is the secondary action of hypertension and the other is the direct action of aldosterone, the active treatments for both blood pressure and hyperaldosteronism itself, are of importance in prevention of cardiovascular event in PA patients. Biomarkers of PA patients did not reveal significant change before and after the treatment. More samples may be required for the conclusion.

 

Nothing to Disclose: KI, YO, EH, MY, KY, SS, TO, KK, MM