CARDIOVASCULAR EVENTS AND TARGET ORGAN DAMAGE IN PRIMARY ALDOSTERONISM

Primary aldosteronism (PA) was considered a rare disorder almost always associated with hypokalemia. The widespread screening of patients with hypertension unveiled an increased prevalence of PA with normokalemic hypertension the prevailing phenotype. Many studies have reported the prevalence of hypokalemia in patients with PA; conversely, the prevalence of PA in patients with hypokalemia is unknown. In this retrospective observational study, we define the prevalence of hypokalemia in referred patients with hypertension and the prevalence of PA in patients with hypokalemia and hypertension. Hypokalemia was present in 15.8% of 5100 patients with hypertension, whereas 76.9% were normokalemic, and 7.3% hyperkalemic. The prevalence of PA in patients with hypokalemia was 28.1% and increased with decreasing potassium concentrations up to 88.5% of patients with spontaneous hypokalemia and potassium concentrations <2.5 mmol/L. A multivariate regression analysis demonstrated the association of hypokalemia with the occurrence of cardiovascular events independent of PA diagnosis. An association of PA with the occurrence of cardiovascular events and target organ damage independent of hypokalemia was also demonstrated. In conclusion, our results confirm that PA is a frequent cause of secondary hypertension in patients with hypokalemia, and the presence of hypertension and spontaneous hypokalemia are strong indications for PA diagnosis. Finally, we show that PA and hypokalemia are associated with an increased risk of cardiovascular events.

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Higher pulse pressure and risk for cardiovascular events in patients with essential hypertension: The Campania Salute Network

European Journal of Preventive Cardiology ◽

10.1177/2047487317747498 ◽

2017 ◽

Vol 25 (3) ◽

pp. 235-243 ◽

Cited By ~ 26

Author(s):

Costantino Mancusi ◽

Maria A Losi ◽

Raffaele Izzo ◽

Grazia Canciello ◽

Maria V Carlino ◽

...

Keyword(s):

Pulse Pressure ◽

Cardiovascular Events ◽

Ventricular Hypertrophy ◽

Target Organ Damage ◽

Organ Damage ◽

Left Ventricular ◽

Target Organ ◽

Major Cardiovascular Events ◽

High Pulse Pressure ◽

High Pulse

Background Increased pulse pressure is associated with structural target organ damage, especially in elderly patients, increasing cardiovascular risk. Design In this analysis, we investigated whether high pulse pressure retains a prognostic effect also when common markers of target organ damage are taken into account. Methods We analysed an unselected cohort of treated hypertensive patients from the Campania Salute Network registry ( n = 7336). Participants with available cardiac and carotid ultrasound were required to be free of prevalent cardiovascular disease, with ejection fraction ≥50%, and no more than stage III Chronic Kidney Disease. The median follow-up was 41 months and end-point was occurrence of major cardiovascular events (i.e. fatal and non-fatal stroke or myocardial infarction and sudden death). Based on current guidelines, pulse pressure ≥60 mm Hg was classified as high pulse pressure ( n = 2356), at the time of the initial visit, whereas pulse pressure <60 mm Hg was considered normal ( n = 4980). Results High pulse pressure patients were older, more likely to be women and diabetic, while receiving more antihypertensive medications than normal pulse pressure (all p < 0.0001). High pulse pressure exhibited greater prevalence of left ventricular hypertrophy, and carotid plaque than normal pulse pressure (all p < 0.0001). In Cox regression, high pulse pressure patients had 57% increased hazard of major cardiovascular events, compared to normal pulse pressure (hazard ratio = 1.57; 95% confidence interval: 1.12–2.22, p = 0.01), an effect that was independent of significant prognostic impact of older age, male sex, diabetes, left ventricular hypertrophy, carotid plaque and less prescription of anti-renin–angiotensin system therapy. Conclusions High pulse pressure is a functional marker of target organ damage, predicting cardiovascular events in hypertensive patients, even independently of well-known structural markers of target organ damage.

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Sodium-glucose co-transporter-2 inhibitors: peculiar “hybrid” diuretics that protect from target organ damage and cardiovascular events

Nutrition Metabolism and Cardiovascular Diseases ◽

10.1016/j.numecd.2020.05.030 ◽

2020 ◽

Vol 30 (10) ◽

pp. 1622-1632

Author(s):

Riccardo Sarzani ◽

Federico Giulietti ◽

Chiara Di Pentima ◽

Francesco Spannella

Keyword(s):

Cardiovascular Events ◽

Target Organ Damage ◽

Organ Damage ◽

Target Organ

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Impact of visit-to-visit blood pressure variability on hypertensive-mediated target organ damage and future cardiovascular events

Journal of Hypertension ◽

10.1097/hjh.0000000000002847 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Costantino Mancusi ◽

Valentina Trimarco ◽

Maria Angela Losi ◽

Grazia Canciello ◽

Carmine Morisco ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Events ◽

Blood Pressure Variability ◽

Target Organ Damage ◽

Organ Damage ◽

Target Organ

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Subclinical target organ damage in primary aldosteronism

Journal of Hypertension ◽

10.1097/hjh.0000000000001642 ◽

2018 ◽

Vol 36 (3) ◽

pp. 701 ◽

Cited By ~ 2

Author(s):

Konstantinos Stavropoulos ◽

Konstantinos P. Imprialos ◽

Michael Doumas ◽

Vasilios G. Athyros ◽

Asterios Karagiannis

Keyword(s):

Primary Aldosteronism ◽

Target Organ Damage ◽

Organ Damage ◽

Target Organ

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Relationship between office and ambulatory blood pressures, target organ damage and cardiovascular events in essential hypertension

American Journal of Hypertension ◽

10.1016/s0895-7061(01)01483-2 ◽

2001 ◽

Vol 14 (4) ◽

pp. A31

Author(s):

A DELASIERRA ◽

A BOVE

Keyword(s):

Essential Hypertension ◽

Cardiovascular Events ◽

Target Organ Damage ◽

Organ Damage ◽

Target Organ ◽

Blood Pressures ◽

Ambulatory Blood Pressures

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Study of correlation of presence of microalbuminuria to target organ damage in essential hypertension cases

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20184764 ◽

2018 ◽

Vol 5 (6) ◽

pp. 1498

Author(s):

Pragati Bhole ◽

Archana Aher

Keyword(s):

Essential Hypertension ◽

Cardiovascular Events ◽

Urinary Albumin Excretion ◽

Target Organ Damage ◽

Organ Damage ◽

Left Ventricular ◽

Urinary Albumin ◽

Target Organ ◽

Hypertensive Patients ◽

Albumin Excretion

Background: Critical amount of urinary albumin excretion has long been reported to be one strong predictor of cardiovascular events in hypertensive patients. Very few studies have been conducted till now depicting correlation of microalbuminuria and target organ damage in patients with essential hypertension, except cardiovascular events. We evaluated the prevalence of microalbuminuria in patients with essential hypertension and its relationship with target organ damage.Methods: Total 120 patients of essential hypertension were studied. Prevalence of urinary albumin excretion and its correlation to target organ damage (left ventricular hypertrophy, retinopathy and stroke) was analysed. Urinary albumin excretion was assessed by turbidimetry method and microalbuminuria was assessed by urine albumin to creatinine ratio.Results: Microalbuminuria was found to be present in 57.7% patients. Target organ damage was observed in 62.5% (75) patients, out of which 78.66% patients had associated microalbuminuria (p <0.05). Amongst them, higher prevalence was observed in patients with longer duration and greater severity of hypertension, increased body mass index and dyslipidemia.Conclusions: Microalbuminuria assessment in hypertensive patients is an important test for the evaluation of target organ damage. Optimal management of hypertension, weight control, and maintenance of normal lipid levels leads to decreased risk of microalbuminuria.

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Salt Appetite and its Effects on Cardiovascular Risk in Primary Aldosteronism

Hormone and Metabolic Research ◽

10.1055/a-1116-2407 ◽

2020 ◽

Vol 52 (06) ◽

pp. 386-393

Author(s):

Christian Adolf ◽

Holger Schneider ◽

Daniel A. Heinrich ◽

Laura Handgriff ◽

Martin Reincke

Keyword(s):

Cardiovascular Risk ◽

Primary Aldosteronism ◽

Salt Intake ◽

Target Organ Damage ◽

Organ Damage ◽

Target Organ ◽

World Health ◽

Salt Appetite ◽

Dietary Salt ◽

Dietary Salt Intake

AbstractFirst described in 1955 by Jerome W. Conn, primary aldosteronism (PA) today is well established as a relevant cause of secondary hypertension and accounts for about 5–10 % of hypertensives. The importance of considering PA is based on its deleterious target organ damage far beyond the effect of elevated blood pressure and on PA being a potentially curable form of hypertension. Aside the established contributory role of high dietary salt intake to arterial hypertension and cardiovascular disease, high salt intake is mandatory for aldosterone-mediated deleterious effects on target-organ damage in patients with primary aldosteronism. Consequently, counselling patients on the need to reduce salt intake represents a major component in the treatment of PA to minimize cardiovascular damage. Unfortunately, in PA patients salt intake is high and far beyond the target values of 5 g per day, recommended by the World Health Organization. Insufficient patient motivation for lifestyle interventions can be further complicated by enhancing effects of aldosterone on salt appetite, via central and gustatory pathways. In this context, treatment for PA by adrenalectomy results in a spontaneous decrease in dietary salt intake and might therefore provide further reduction of cardiovascular risk in PA than specific medical treatment alone. Furthermore, there is evidence from clinical studies that even after sufficient treatment of PA dietary salt intake remains a relevant prognostic factor for cardiovascular risk. This review will focus on the synergistic benefits derived from both blockade of aldosterone-mediated effects and reduction in dietary salt intake on cardiovascular risk.

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