【論文摘要】Reversal of Arterial Stiffness in Medically and Surgically Treated Primary Aldosteronism

10.6907/SCJ.201909/SP_1(2).0139

Zheng-Wei Chen；Yen-Hung Lin；Chi-Shen Hung；Chien-Ting Pan；Yi-Yao Chang；Che-Wei Liao；Vin-Cent Wu

海峽循環醫學雜誌

1卷2S期（2019 / 09 / 01）

173 - 173

英文

Background/Synopsis: Hyperaldosteronism has several adverse effects on cardiovascular structure and function. The aldosterone excess cause vessel endothelium dysfunction, collagen synthesis in the vascular wall, increased arterial wall stiffness and atherosclerosis. Pulse wave velocity (PWV) has been widely used as a non-invasive tool to evaluate arterial wall stiffness. A greater PWV represents a stiffer arterial wall. In our previous study, primary aldosteronism (PA) patients showed higher degree of arterial stiffness than essential hypertension (EH) patients. Also, the improvement of PWV was found in post-treatment PA patients either receiving adrenalectomy or medication control, though the effect was more prominent in adrenalectomy group. The cause might be the insufficient mineralocorticoid receptor (MR) blockade and inadequate treatment response in medical treatment group. Objectives/Purpose: We aimed to analysis the treatment effect of medication and operation via PWV analysis. Methods/Results: Methods: We prospectively enrolled patients with PA and EH and analyzed their clinical data, biochemical data. Blood pressure and PWV, including brachial-ankle PWV (baPWV) and heart-ankle PWV (haPWV), were obtained before treatment and 12 months after treatment. We had further categorized medically treated PA patient according to post-treatment plasma renin activity (PRA) into two groups. Suppressed (＜ 1 ng/mL/h) indicated sufficient MR blockade, whereas substantially increased PRA (≥1 ng/mL/h) revealed insufficient MR blockade. Results: Total 411 PA patients, with 235 patients receiving adrenalectomy (Group 1) and 176 patients receiving medication control (Group 2: 75 patients with post-treatment PRA ＜ 1 ng/mL/h; Group 3: 101 patients with post-treatment PRA ≥ 1 ng/mL/h), were enrolled for analysis. After ANOVA test, we found significant difference of ΔhaPWV between 3 groups (Group 1 vs. Group 2 vs. Group 3: -40 ±118 vs. 23 ±318 vs. -39 ± 119 cm/s, p=0.017). Post-hoc analysis showed comparable improvement between patients receiving adrenalectomy and patients receiving medical control with post-treatment PRA ≥ 1 ng/mL/h (p=0.937). However, as to ΔbaPWV analysis, the trend could also be observed but without statistical significance (Group 1 vs. Group 2 vs. Group 3: -78 ±243 vs. -34 ±242 vs. -103 ± 259 cm/s, p=0.182). Conclusion: The improvement of PWV indicate reversal of arterial stiffness in PA patients either receiving adrenalectomy or medication control. The effect was comparable between surgically treated PA patients and medically treated PA patients with sufficient MR blockade (post treatment PRA ≥1 ng/mL/h).