Primary aldosteronism: Higher volume load, cardiac output and arterial stiffness than in essential hypertension

• Published in: Journal of internal medicine Vol. 289; no. 1; pp. 29 - 41
• Main Authors: Choudhary, M. K., Värri, E., Matikainen, N., Koskela, J., Tikkakoski, A. J., Kähönen, M., Niemelä, O., Mustonen, J., Nevalainen, P. I., Pörsti, I.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.01.2021
• Subjects: Age composition; Antihypertensives; Aorta; arterial stiffness; Blood pressure; Body mass; Body mass index; Body size; Cardiac output; Endocrine disorders; extracellular water; Heart; Hemodynamics; Hypertension; primary aldosteronism; Sex; Stiffness; Water balance; Wave analysis; Wave reflection; Wave resistance; Wave velocity; arterial stiffness; cardiac output; extracellular water; hypertension; primary aldosteronism
• ISSN: 0954-6820; 1365-2796; 1365-2796
• DOI: 10.1111/joim.13115

Background The diagnostics of primary aldosteronism (PA) are usually carried out in patients taking antihypertensive medications. We compared haemodynamics between medicated PA, medicated essential hypertension (EH), never‐medicated EH and normotensive controls (n = 130 in all groups). Methods The hypertensive groups were matched for age (53 years), sex (84 male/46 female) and body mass index (BMI) (30 kg m−2); normotensive controls had similar sex distribution (age 48 years, BMI 27 kg m−2). Haemodynamics were recorded using whole‐body impedance cardiography and radial pulse wave analysis, and the results were adjusted as appropriate. Radial blood pressure recordings were calibrated by brachial blood pressure measurements from the contralateral arm. Results Radial and aortic systolic and diastolic blood pressure was similar in PA and never‐medicated EH, and higher than in medicated EH and normotensive controls (P ≤ 0.001 for all comparisons). Extracellular water balance was ~ 4% higher in PA than in all other groups (P < 0.05 for all), whilst cardiac output was ~ 8% higher in PA than in medicated EH (P = 0.012). Systemic vascular resistance and augmentation index were similarly increased in PA and both EH groups when compared with controls. Pulse wave velocity was higher in PA and never‐medicated EH than in medicated EH and normotensive controls (P ≤ 0.033 for all comparisons). Conclusions Medicated PA patients presented with corresponding systemic vascular resistance and wave reflection, but higher extracellular water volume, cardiac output and arterial stiffness than medicated EH patients. Whether the systematic evaluation of these features would benefit the clinical diagnostics of PA remains to be studied in future.