Reversal of Arterial Stiffness in Primary Aldosteronism After Treatment
Date Issued
2015
Date
2015
Author(s)
Liao, Che-Wei
Abstract
Primary aldosteronism (PA) was one of the most common causes of secondary hypertension. Exposure to excessive aldosterone led to increased arterial stiffness. The effect of adrenalectomy on arterial stiffness reversibility was seldom reported. Besides, the time course of arterial stiffness reversal and the actual predicting factors on arterial stiffness reversal were still unclear. We prospectively enrolled 102 patients with aldosterone producing adenoma (APA) from March 2006 to January 2012. We measured the pulse wave velocity (PWV) between brachial-ankle (baPWV) and heart-ankle (haPWV) before, and 6 months and 12 months after adrenalectomy of all enrolled patients. All other physiological and biochemistry parameters were collected at the same time and analyzed after the 1-year follow-up. The baseline baPWV averaged as 1636± 310 cm/s while haPWV as 1096±138cm/s. The determinant factors to baseline baPWV were age, duration of hypertension, and baseline systolic blood pressure (SBP) after multi-variable linear regression analysis. Similarly, the determinant factors for baseline haPWV were age, duration of hypertension, baseline systolic pressure and diastolic pressure (DBP). After treatment, the patients’ PWV decreased significantly during the first 6-month (baPWV 1533 ± 278 at 6-month, p < 0.001; haPWV 1048±129 at 6-month, p<0.001). No further reduction was noted during the following 6 month (baPWV 1562±31 at 12-month, p = 0.248; haPWV 1049±130 at 12-month, p=0.415). After multi-variable regression analysis, the determinants of baPWV decrement at 6 months (ΔbaPWV0-6mo) were decrement of diastolic blood pressure at 6 months (ΔDBP0-6mo) and the baseline baPWV. On the other hand, the determinants for the change of haPWV at 6 months (ΔhaPWV0-6mo) were baseline haPWV, ΔDBP0-6mo and the change of log-transformed plasma renin activity (ΔLogPRA0-6mo) The arterial stiffness of APA patients could be reversed after surgical treatment in the first 6 months after adrenalectomy. The determinant factors of baseline PWV included age, duration of hypertension and baseline SBP, and baseline DBP (for haPWV). The determinant factors of ΔPWV are baseline PWV, ΔDBP0-6mo and ΔLogPRA0-6mo (for ΔhaPWV). Since higher PWV was closely correlated with higher cardiovascular risks, the decrease in PWV might also imply reducing CV disease risks. However, we needed a further large scale clinical trial focusing on the long-term outcomes to clarify this.
Subjects
primary aldosteronism
adenoma
adrenalectomy
PWV
arterial stiffness
Type
thesis
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