Original Investigation
Cardiovascular complications in patients with primary aldosteronism

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Abstract

Primary aldosteronism (PA) is widely believed to be a relatively benign form of hypertension associated with a low incidence of vascular complications. However, several recent studies showed that cardiovascular complications were not rare in PA. PA is known as one of the most typical forms of sodium-sensitive hypertension. Recently, we found that the sodium sensitivity of blood pressure was a marker for greater risk for cardiovascular complications, especially stroke, in patients with essential hypertension. Therefore, we investigated cardiovascular complications in 58 patients with PA confirmed to be Conn's adenoma. Cardiovascular complications were found in 34% of 58 patients. Coronary artery disease was found in only one patient (1.7%), as angina pectoris. Stroke was found in nine patients (15.5%), four patients (6.9%) with cerebral infarctions and five patients (8.6%) with cerebral hemorrhages. Proteinuria and renal insufficiency were found in 14 (24.1%) and 4 (6.9%) patients, respectively. The incidence of cerebral infarction and renal insufficiency was greater in men than women. The prevalence of proteinuria was greater in patients with than without stroke (P = 0.03) among those aged older than 40 years. These results indicated that cardiovascular complications, especially stroke and proteinuria, were common in patients with PA, and proteinuria might be an indicator for stroke as target-organ damage.

Section snippets

Methods

During the 19-year period from 1977 to 1996, 58 patients with PA caused by unilateral adenoma (Conn's syndrome) were admitted to the National Cardiovascular Center Hospital (Osaka, Japan). The diagnosis of PA was based on an elevated plasma aldosterone concentration/renin activity ratio that was unresponsive to a captopril test and on computed tomographic scans of the adrenal grand. It was confirmed by histological analysis of the removed adenoma after unilateral adrenalectomy in 47 patients.

Results

The clinical characteristics of the studied patients with PA are listed in Table 1.

. Clinical Characteristics of Studied Patients With Primary Aldosteronism

ParameterEmpty Cell
Age (yr)45 ± 9
Sex (men/women)31/27
Known duration of hypertension (yr)7.4 ± 6.5
Body mass index (kg/m2)22.8 ± 3.4

NOTE. Values expressed as mean ± standard deviation or number of patients.

The mean age of the patients was 45 ± 9 years (range, 25 to 69 years). The mean duration of hypertension was 7.4 ± 6.5 years, and the mean

Discussion

It has been widely believed that PA is a benign type of hypertension with a low incidence of cardiovascular complications. Therefore, it has been emphasized that hypertensive patients with low plasma renin activity, as in PA, had fewer cardiovascular complications than those with normal and elevated plasma renin activity.2, 3 However, several studies showed cardiovascular complications were not rare in PA.4, 5, 6 In the present study, we found cardiovascular complications in 34% of the patients

Acknowledgements

Acknowledgment: The authors thank Keiko Tanegashima for her excellent secretarial work.

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    Received February 13, 1998; accepted in revised form August 14, 1998.

    Supported by in part by grants no. C-1995-3 and A-1997-9 from Research Grants for Cardiovascular Diseases and for Scientific Research Expenses for Health and Welfare Programs and Funds for Comprehensive Research on Long-Term Chronic Disease (Renal Failure) from the Ministry of Health and Welfare of Japan; grants from Salt Science Research Foundation, Tokyo; Japan Cardiovascular Research Foundation; and Takeda Science Foundation, Osaka.

    Address reprint requests to Genjiro Kimura, MD, Chief, Division of Nephrology, National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan. E-mail: [email protected]

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