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Comparative Study
. 2024 Oct 14;37(11):884-892.
doi: 10.1093/ajh/hpae087.

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

Affiliations
Comparative Study

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

Eeva Kokko et al. Am J Hypertens. .

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: blood pressure; cardiac work; hypertension; primary aldosteronism.

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Conflict of interest statement

The authors declared no conflict of interest.

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Cross-sectional study: 5-minute recordings show aortic systolic (a) and diastolic (b) blood pressure, heart rate (c), stroke index (d), cardiac index (e), and left cardiac work index (f) among 51 patients with bilateral and 63 patients with unilateral primary aldosteronism.
Figure 2.
Figure 2.
Follow-up study: 5-minute recordings show aortic systolic and diastolic blood pressure in 20 patients with bilateral and 20 patients with unilateral primary aldosteronism before (a, c) and after (b, d) 31–35 months of targeted treatment.
Figure 3.
Figure 3.
Follow-up study: heart rate, stroke index, and cardiac index in 20 patients with bilateral and 20 patients with unilateral primary aldosteronism before (a, c, e) and after (b, d, f) 31–35 months of targeted treatment.
Figure 4.
Figure 4.
Follow-up study: left cardiac work index and extracellular water volume in 20 patients with bilateral and 20 patients with unilateral primary aldosteronism before (a, c) and after (b, d) 31–35 months of targeted treatment.

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