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Spectrum of primary hyperaldosteronism in adults with hypertension: effects on cardiac remodeling
Session:
Sessão de Comunicações Orais 11 – Corações espessos e rígidos: amiloidose cardíaca e companhia
Speaker:
António Afonso Angélico Gonçalves
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
27. Hypertension
Subtheme:
27.1 Hypertension – Pathophysiology and Mechanisms
Session Type:
Comunicações Orais
FP Number:
---
Authors:
António Afonso Angélico Gonçalves; Ana Rita Leite; Tiago Godinho; Adelino Leite Moreira; João Pedro Ferreira; João Sérgio Neves
Abstract
<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Introduction</strong>: Primary aldosteronism (PA) is a state of autonomous, renin-independent aldosterone production and is linked with </span><span style="font-family:"Arial",sans-serif">harmful metabolic and cardiovascular effects</span><span style="font-family:Arial,Helvetica,sans-serif">. Limited research has explored its impact on cardiac remodeling on patients with hypertension.</span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Aim: </strong>To evaluate the impact of primary aldosteronism in heart remodeling of patients with hypertension.</span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Methods</strong>: We assessed participants from the Generation 3 cohort of the Framingham Heart Study during their initial visit (2002–2005), where aldosterone and plasma renin activity (PRA) levels were measured and echocardiography was performed. We only included patients with a diagnosis of hypertension. Multivariate linear regression models adjusted for relevant baseline variables were used to examine the associations of PRA and Aldosterone to renin ratio (ARR) with echocardiographic parameters. </span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Results</strong>: A total of 1308 patients were included (mean age 43.9±8.1, 34.9% female, 98.0% white, 49.2% with dyslipidemia, 8.7% with diabetes, 6.1% with coronary artery disease, 1.6% with heart failure, 1.4% with atrial fibrillation, 15.7% smokers). </span><span style="font-family:"Arial",sans-serif">A total of 94 (7.2%) had a positive screening for primary hyperaldosteronism. </span><span style="font-family:Arial,Helvetica,sans-serif">Baseline left ventricle mass index (LVMI) was 79.4±13.4 g/m<sup>2</sup>, LV end-diastolic volume index (LVEDVI) was 51.9±10.1 ml/m<sup>2</sup>, LV end systolic volume index (LVEDVI) was 19.0±4.4 ml/m<sup>2</sup>, interventricular septal thickness was 0.97±0.14 cm, left atrial internal diastolic dimension was 2.92±0.48 cm, LV ejection fraction (EF) was 63.5±4.1%, lateral E’ velocity was 10.9±2.5 cm/s, E/e’ ratio was 6.42±1.78 and E/A ratio was 1.23±0.33. A total of 94 (7.2%) met criteria for primary hyperaldosteronism. PRA had a negative correlation with LVMI (</span>β<span style="font-family:Arial,Helvetica,sans-serif">= -0.77, 95% Confidence Interval [CI] -1.42 to -0.12, p=0.20), LVEDVI (</span>β<span style="font-family:Arial,Helvetica,sans-serif">= -0.76, 95% CI -1.24 to -0.28, p=0.02) and LVSVI (</span>β<span style="font-family:Arial,Helvetica,sans-serif">= -0.35, 95%E CI -0.56 to -0.14, p=0.001). ARR had a positive correlation with LVMI (</span>β<span style="font-family:Arial,Helvetica,sans-serif">= 0.70, 95% CI 0.12 to 1.29, p=0.019), LVEDVI (</span>β<span style="font-family:Arial,Helvetica,sans-serif">= 0.70, 95% CI 0.26 to 1.13, p=0.002), LVESVI (</span>β<span style="font-family:Arial,Helvetica,sans-serif">= 0.26, 95% CI 0.07 to 0.45, p=0.008). No meaningful associations were found between PRA or ARR and LVEF or diastolic function parameters.</span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Conclusions</strong>: Increased aldosterone was significantly associated with increased LVMI, LVEDVI and LVESVI, which is compatible with a pattern of excentric remodeling. These findings suggest that hyperaldosteronism may play an unrecognized role in adverse remodeling in patients with hypertension.</span></span></p>
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