Abstract 15485: Long-Term Regression of Left Ventricular Hypertrophy Through Inward Remodeling with Specific Treatment of Primary Aldosteronism
Context: Primary aldosteronism (PA), a highly prevalent curable form of high blood pressure, causes left ventricular (LV) hypertrophy and an excess rate of cardiovascular (CV) events, including atrial fibrillation.
Objective: to assess if specific treatment of PA reverses LV hypertrophy during long-term follow-up. Design, Setting, Participants and Main Outcome Measure. We prospectively recruited 321 patients in a long-term study entailing serial echocardiography and Doppler evaluations. Of them 171 had PA and were assigned to either adrenalectomy (n=100) or medical therapy (n=71) based on adrenal vein sampling. The remaining 150 were optimally treated primary hypertensive (PH) patients.
Results and conclusions. At baseline the PA patients had a higher prevalence of inappropriate LV mass than PH patients. Treatment lowered blood pressure (BP) to similar values (136±15/85±8 mmHg) at long-term follow-up (median 2.7 years) in the PA and PH. Significantly less drugs were necessary to this goal in the adrenalectomized PA patients than in the other groups. LV remodeling around a smaller cavity occurred in both adrenalectomized and medically treated PA patients and lowered the LV mass index to the level of optimally treated PH patients. Notwithstanding this, the proportion of PA patients with inappropriate LV mass paradoxically increased at follow-up. Hence, treatment of PA reverses the adverse LV changes induced by hyperaldosteronism at long-term, but does not warrant restitutio ad integrum, thus emphasizing the crucial importance of an early diagnosis and treatment of PA.
- © 2012 by American Heart Association, Inc.