A variety of abnormalities that occur in patients with primary
aldosteronism indicate the capability of elevated
aldosterone to induce cardiac damage over that induced by
hypertension itself. This study investigates factors that can predict structural and functional changes of the heart
after treatment of primary
aldosteronism in a post-hoc analysis of 54 patients who were enrolled in a long-term follow-up study that was conducted after either
adrenalectomy or treatment with
spironolactone. Cardiac ultrasound assessment was performed before treatment and after with an average follow-up of 6.4 years. During follow-up, blood pressure decreased significantly and comparably in both treatment groups. In both treatment groups, left ventricular mass decreased significantly with a trend to improved diastolic filling profile and no changes in ventricular geometry. At univariate analysis, changes in left ventricular mass induced by treatment of primary
aldosteronism were directly related with changes in systolic blood pressure and pretreatment plasma
aldosterone levels measured both at baseline and after an intravenous saline load. This relationship was maintained when patients treated with
adrenalectomy and
spironolactone were analyzed separately. Multivariate regression analysis showed that changes in systolic blood pressure and pretreatment
aldosterone levels were independent predictors of left ventricular mass changes
after treatment. This study strongly supports a role of
aldosterone in promoting
left ventricular hypertrophy that is independent of the
hypertension-related hemodynamic load and suggests a practical way to predict left ventricular mass changes following surgical and medical treatment of primary
aldosteronism.