Targeted Treatment Reverses Increased Left Cardiac Work in Unilateral vs. Bilateral Primary Aldosteronism

• Published in: American journal of hypertension Vol. 37; no. 11; pp. 884 - 892
• Main Authors: Kokko, Eeva, Viukari, Marianna, Koskela, Jenni K, Choudhary, Manoj Kumar, Matikainen, Niina, Mustonen, Jukka, Nevalainen, Pasi I, Pörsti, Ilkka
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 14.10.2024
• Subjects: Adrenalectomy; Adult; Aged; Cardiac Output - drug effects; Cardiography, Impedance; Cross-Sectional Studies; Female; Hemodynamics - drug effects; Humans; Hyperaldosteronism - complications; Hyperaldosteronism - drug therapy; Hyperaldosteronism - physiopathology; Hyperaldosteronism - surgery; Male; Middle Aged; Mineralocorticoid Receptor Antagonists - therapeutic use; Original Contributions; Pulse Wave Analysis; Spironolactone - therapeutic use; Time Factors; Treatment Outcome; Ventricular Function, Left - drug effects; blood pressure; cardiac work; hypertension; primary aldosteronism
• ISSN: 0895-7061; 1941-7225; 1941-7225
• DOI: 10.1093/ajh/hpae087

The incidence of cardiovascular complications may be higher in unilateral than bilateral primary aldosteronism (PA). We compared noninvasive hemodynamics after targeted therapy of bilateral vs. unilateral PA. Adrenal vein sampling was performed, and hemodynamics recorded using radial artery pulse wave analysis and whole-body impedance cardiography (n = 114). In 40 patients (adrenalectomy n = 20, spironolactone-based treatment n = 20), hemodynamic recordings were performed after 33 months of PA treatment. In initial cross-sectional analysis, 51 patients had bilateral and 63 unilateral PA. The mean ages were 50.6 and 54.3 years (P = 0.081), and body mass indexes 30.3 and 30.6 kg/m2 (P = 0.724), respectively. Aortic blood pressure (BP) and cardiac output did not differ between the groups, but left cardiac work was ~10% higher in unilateral PA (P = 0.022). In the follow-up study, initial and final BPs in the aorta were not significantly different, while initial cardiac output (+13%, P = 0.015) and left cardiac work (+17%, P = 0.009) were higher in unilateral than bilateral PA. After median treatment of 33 months, the differences in cardiac load were abolished, and extracellular water volume was reduced by 1.3 and 1.4 l in bilateral vs. unilateral PA, respectively (P = 0.814). These results suggest that unilateral PA burdens the heart more than bilateral PA, providing a possible explanation for the higher incidence of cardiac complications in unilateral disease. A similar reduction in aldosterone-induced volume excess was obtained with targeted surgical and medical treatment of PA.