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Cardiovascular Complications Associated With Primary Aldosteronism: A Controlled Cross-Sectional Study
Abstract
A higher risk of cardiovascular events has been reported in patients with primary aldosteronism (PA) than in otherwise similar patients with essential hypertension (EH). However, the evidence is limited by small sample size and potential confounding factors. We, therefore, compared the prevalence of cardiovascular events in 459 patients with PA diagnosed in our hypertension unit from 2001 to 2006 and 1290 controls with EH. PA cases and EH controls were individually matched for sex, age (±2 years), and office systolic blood pressure (±10 mm Hg). Patients with PA and EH differed significantly in duration of hypertension, serum potassium, plasma aldosterone and plasma renin concentrations, aldosterone-to-renin ratio, and urinary aldosterone concentration (P<0.001 for all comparisons). The prevalence of electrocardiographic and echocardiographic left ventricular hypertrophy was about twice higher in patients with PA even after adjustment for hypertension duration. PA patients also had a significantly higher prevalence of coronary artery disease (adjusted odds ratio, 1.9), nonfatal myocardial infarction (adjusted odds ratio, 2.6), heart failure (adjusted odds ratio, 2.9), and atrial fibrillation (adjusted odds ratio, 5.0). The risks associated with PA were similar across levels of serum potassium and plasma aldosterone. To conclude, patients with PA are more likely to have had a cardiovascular complication at diagnosis than otherwise similar patients with EH. Target organ damage and complications disproportionate to blood pressure should be considered as an additional argument for suspecting PA in a given individual and possibly for broadening the scope of screening at the population level.
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“Primary aldosteronism is also associated with left ventricular hypertrophy, diastolic dysfunction and heart failure, large artery stiffness, oxidative stress, widespread tissue inflammation and fibrosis, and increased resistance vessel remodeling compared with primary hypertension.291–293”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [291]
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Metadata
- Authors
- Savard, S., Amar, L., Plouin, P.-F., & Steichen, O.
- Affiliations
- Assistance Publique – Hôpitaux de Paris (FR)
- Venue
- Hypertension
- Published
- 2013-08
- Volume
- 62
- Issue
- 2
- Pages
- 331-336
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2168924012
- Cited by
- 505
- References
- 50
- Citations by year
- 2026: 24 · 2025: 34 · 2024: 37 · 2023: 39 · 2022: 48 · 2021: 46 · 2020: 41 · 2019: 43 · 2018: 38 · 2017: 47 · 2016: 32 · 2015: 37 · 2014: 29 · 2013: 10
- FWCI
- 28.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Health Sciences › Medicine › Nephrology › Potassium and Related Disorders
- Keywords
- primary aldosteronism, cardiovascular complications, essential hypertension, left ventricular hypertrophy, coronary artery disease, myocardial infarction, heart failure, atrial fibrillation, aldosterone-renin ratio, serum potassium, plasma aldosterone, target organ damage
- MeSH terms
- Adult, Cardiovascular Diseases, Cross-Sectional Studies, Female, Humans, Hyperaldosteronism, Hypertension, Male, Middle Aged, Hypertrophy, Left Ventricular
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