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Patients with primary aldosteronism (PA) are at increased cardiovascularrisk, compared to patients with essential hypertension (EH). Cardiovasculardamage could depend on PA phenotype, potentially being lower in milder formsof PA. Our aim was to assess atherosclerotic burden and arterial stiffnessin 88 prospectively recruited patients, including 44 patients with mild PAand EH respectively. All patients underwent a structured study program,including measurements of ankle-brachial index, oscillometric measurement ofcentral pulse wave velocity (cPWV) and vascular ultrasound examination ofthe supraaortic arteries, the abdominal aorta, and the femoropoplitealarteries. A plaque score was calculated to estimate atherosclerotic burdenfor each patient. This is a prospective case-control study set at a tertiarycare hospital. Patients with PA and EH matched well for age, gender, bloodpressure, BMI, and cardiovascular risk factors such as diabetes mellitus andsmoking status. Common carotid intima-media thickness (0.77 vs.0.75 mm; p=0.997) and cPWV (7.2 vs. 7.1 m/s;p=0.372) were comparable between patients with PA and EH. Theatherosclerotic burden, as expressed by the plaque score, did not differbetween the two groups (p=0.159). However, after initiation oftreatment cPWV was significantly decreased in patients with PA(p=0.017). This study shows that subclinical atherosclerotic burdenand arterial stiffness in patients with milder forms of PA is comparable topatients with EH. Nevertheless, specific treatment for PA significantlyimproved cPWV, which argues for a more liberal use of mineralocorticoidreceptor antagonists in patients with arterial hypertension.

hormone and metabolic research

Atherosclerotic Burden and Arterial Stiffness are Not Increased in Patients with Milder Forms of Primary Aldosteronism Compared to Patients with Essential Hypertension