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Primary Aldosteronism and Cerebrovascular Diseases

  • Chen, Zheng-Wei (Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Hung, Chi-Sheng (Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Wu, Vin-Cent (Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Lin, Yen-Hung (Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • TAIPAI study group (TAIPAI study group)
  • Received : 2018.10.04
  • Accepted : 2018.10.30
  • Published : 2018.12.31

Abstract

As diagnostic techniques have advanced, primary aldosteronism (PA) has emerged as the most common cause of secondary hypertension. The excess of aldosterone caused by PA resulted in not only cardiovascular complications, including coronary artery disease, myocardial infarction, arrhythmia, and heart failure, but also cerebrovascular complications, such as stroke and transient ischemic attack. Moreover, PA is associated more closely with these conditions than is essential hypertension. In this review, we present up-to-date findings on the association between PA and cerebrovascular diseases.

Acknowledgement

Supported by : National Taiwan University Hospital, Ministry of Science and Technology

References

  1. Gyamlani G, Headley CM, Naseer A, Valaulikar GS, Geraci SA. Primary aldosteronism: diagnosis and management. Am J Med Sci 2016;352:391-8. https://doi.org/10.1016/j.amjms.2016.06.015
  2. Rossi GP. Prevalence and diagnosis of primary aldosteronism. Curr Hypertens Rep 2010;12:342-8. https://doi.org/10.1007/s11906-010-0134-2
  3. Vilela LAP, Almeida MQ. Diagnosis and management of primary aldosteronism. Arch Endocrinol Metab 2017;61:305-12. https://doi.org/10.1590/2359-3997000000274
  4. Ohno Y, Sone M, Inagaki N, Yamasaki T, Ogawa O, Takeda Y, et al. Prevalence of cardiovascular disease and its risk factors in primary aldosteronism: a multicenter Study in Japan. Hypertension 2018;71:530-7. https://doi.org/10.1161/HYPERTENSIONAHA.117.10263
  5. Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circ Res 2017;120:439-48. https://doi.org/10.1161/CIRCRESAHA.116.308413
  6. Renna NF, de Las Heras N, Miatello RM. Pathophysiology of vascular remodeling in hypertension. Int J Hypertens 2013;2013:808353.
  7. Calo LA, Armanini D. Aldosterone-mediated endothelial remodeling and oxidative stress. Kidney Int 2005;68:1899. https://doi.org/10.1038/ki.2005.4496300
  8. Mattsson C, Young WF Jr. Primary aldosteronism: diagnostic and treatment strategies. Nat Clin Pract Nephrol 2006;2:198-208.
  9. Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2003;2:43-53. https://doi.org/10.1016/S1474-4422(03)00266-7
  10. Nakano S, Kobayashi N, Yoshida K, Ohno T, Matsuoka H. Cardioprotective mechanisms of spironolactone associated with the angiotensin-converting enzyme/epidermal growth factor receptor/extracellular signal-regulated kinases, NAD(P)H oxidase/lectin-like oxidized low-density lipoprotein receptor-1, and Rho-kinase pathways in aldosterone/ salt-induced hypertensive rats. Hypertens Res 2005;28:925-36. https://doi.org/10.1291/hypres.28.925
  11. Rocha R, Martin-Berger CL, Yang P, Scherrer R, Delyani J, McMahon E. Selective aldosterone blockade prevents angiotensin II/salt-induced vascular inflammation in the rat heart. Endocrinology 2002;143:4828-36. https://doi.org/10.1210/en.2002-220120
  12. Briet M, Schiffrin EL. Vascular actions of aldosterone. J Vasc Res 2013;50:89-99. https://doi.org/10.1159/000345243
  13. Mazak I, Fiebeler A, Muller DN, Park JK, Shagdarsuren E, Lindschau C, et al. Aldosterone potentiates angiotensin IIinduced signaling in vascular smooth muscle cells. Circulation 2004;109:2792-800. https://doi.org/10.1161/01.CIR.0000131860.80444.AB
  14. Kasal DA, Barhoumi T, Li MW, Yamamoto N, Zdanovich E, Rehman A, et al. T regulatory lymphocytes prevent aldosterone-induced vascular injury. Hypertension 2012;59:324-30. https://doi.org/10.1161/HYPERTENSIONAHA.111.181123
  15. Bernini G, Galetta F, Franzoni F, Bardini M, Taurino C, Bernardini M, et al. Arterial stiffness, intima-media thickness and carotid artery fibrosis in patients with primary aldosteronism. J Hypertens 2008;26:2399-405. https://doi.org/10.1097/HJH.0b013e32831286fd
  16. Strauch B, Petrak O, Wichterle D, Zelinka T, Holaj R, Widimsky J Jr. Increased arterial wall stiffness in primary aldosteronism in comparison with essential hypertension. Am J Hypertens 2006;19:909-14. https://doi.org/10.1016/j.amjhyper.2006.02.002
  17. Strauch B, Petrak O, Zelinka T, Wichterle D, Holaj R, Kasalicky M, et al. Adrenalectomy improves arterial stiffness in primary aldosteronism. Am J Hypertens 2008;21:1086-92. https://doi.org/10.1038/ajh.2008.243
  18. Brown NJ. Eplerenone: cardiovascular protection. Circulation 2003;107:2512-8. https://doi.org/10.1161/01.CIR.0000071081.35693.9A
  19. Benetos A, Lacolley P, Safar ME. Prevention of aortic fibrosis by spironolactone in spontaneously hypertensive rats. Arterioscler Thromb Vasc Biol 1997;17:1152-6. https://doi.org/10.1161/01.ATV.17.6.1152
  20. Blacher J, Asmar R, Djane S, London GM, Safar ME. Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients. Hypertension 1999;33:1111-7. https://doi.org/10.1161/01.HYP.33.5.1111
  21. Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, et al. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation 2006;113:657-63. https://doi.org/10.1161/CIRCULATIONAHA.105.555235
  22. Touboul PJ, Labreuche J, Vicaut E, Amarenco P; GENIC Investigators. Carotid intima-media thickness, plaques, and Framingham risk score as independent determinants of stroke risk. Stroke 2005;36:1741-5. https://doi.org/10.1161/01.STR.0000174490.23495.57
  23. Harris S. The association of carotid intima-media thickness (cIMT) and stroke: a cross sectional study. Perspect Med 2012;1:164-6. https://doi.org/10.1016/j.permed.2012.04.007
  24. Lin YH, Lin LY, Chen A, Wu XM, Lee JK, Su TC, et al. Adrenalectomy improves increased carotid intima-media thickness and arterial stiffness in patients with aldosterone producing adenoma. Atherosclerosis 2012;221:154-9. https://doi.org/10.1016/j.atherosclerosis.2011.12.003
  25. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983-8. https://doi.org/10.1161/01.STR.22.8.983
  26. Bjorck S, Palaszewski B, Friberg L, Bergfeldt L. Atrial fibrillation, stroke risk, and warfarin therapy revisited: a population-based study. Stroke 2013;44:3103-8. https://doi.org/10.1161/STROKEAHA.113.002329
  27. Porodko M, Auer J, Eber B. Conn's syndrome and atrial fibrillation. Lancet 2001;357:1293-4.
  28. Al-Aloul B, Li JM, Benditt D, Tholakanahalli V. Atrial fibrillation associated with hypokalemia due to primary hyperaldosteronism (Conn's syndrome). Pacing Clin Electrophysiol 2006;29:1303-5. https://doi.org/10.1111/j.1540-8159.2006.00536.x
  29. Watson T, Karthikeyan VJ, Lip GY, Beevers DG. Atrial fibrillation in primary aldosteronism. J Renin Angiotensin Aldosterone Syst 2009;10:190-4. https://doi.org/10.1177/1470320309342734
  30. Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol 2005;45:1243-8. https://doi.org/10.1016/j.jacc.2005.01.015
  31. Monticone S, Burrello J, Tizzani D, Bertello C, Viola A, Buffolo F, et al. Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice. J Am Coll Cardiol 2017;69:1811-20.
  32. Rossi GP, Cesari M, Cuspidi C, Maiolino G, Cicala MV, Bisogni V, et al. Long-term control of arterial hypertension and regression of left ventricular hypertrophy with treatment of primary aldosteronism. Hypertension 2013;62:62-9. https://doi.org/10.1161/HYPERTENSIONAHA.113.01316
  33. Catena C, Colussi G, Nadalini E, Chiuch A, Baroselli S, Lapenna R, et al. Cardiovascular outcomes in patients with primary aldosteronism after treatment. Arch Intern Med 2008;168:80-5. https://doi.org/10.1001/archinternmed.2007.33
  34. Mulatero P, Monticone S, Bertello C, Viola A, Tizzani D, Iannaccone A, et al. Long-term cardio- and cerebrovascular events in patients with primary aldosteronism. J Clin Endocrinol Metab 2013;98:4826-33. https://doi.org/10.1210/jc.2013-2805
  35. Savard S, Amar L, Plouin PF, Steichen O. Cardiovascular complications associated with primary aldosteronism: a controlled cross-sectional study. Hypertension 2013;62:331-6. https://doi.org/10.1161/HYPERTENSIONAHA.113.01060
  36. Monticone S, D'Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2018;6:41-50. https://doi.org/10.1016/S2213-8587(17)30319-4
  37. Rocha R, Stier CT Jr. Pathophysiological effects of aldosterone in cardiovascular tissues. Trends Endocrinol Metab 2001;12:308-14. https://doi.org/10.1016/S1043-2760(01)00432-5
  38. Murata M, Kitamura T, Tamada D, Mukai K, Kurebayashi S, Yamamoto T, et al. Plasma aldosterone level within the normal range is less associated with cardiovascular and cerebrovascular risk in primary aldosteronism. J Hypertens 2017;35:1079-85. https://doi.org/10.1097/HJH.0000000000001251
  39. Hayashi R, Tamada D, Murata M, Mukai K, Kitamura T, Otsuki M, et al. saline infusion test highly associated with the incidence of cardio- and cerebrovascular events in primary aldosteronism. Endocr J 2017;64:507-13. https://doi.org/10.1507/endocrj.EJ16-0337
  40. Kao CC, Wu CH, Lin YH, Chang CC, Chen HH, Wu MS, et al. Risk of ischemic stroke in primary aldosteronism patients. Clin Chim Acta 2015;438:86-9. https://doi.org/10.1016/j.cca.2014.08.007
  41. Rossi GP, Maiolino G, Flego A, Belfiore A, Bernini G, Fabris B, et al. Adrenalectomy lowers incident atrial fibrillation in primary aldosteronism patients at long term. Hypertension 2018;71:585-91. https://doi.org/10.1161/HYPERTENSIONAHA.117.10596
  42. Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Incidence of atrial fibrillation and mineralocorticoid receptor activity in patients with medically and surgically treated primary aldosteronism. JAMA Cardiol 2018;3:768-74. https://doi.org/10.1001/jamacardio.2018.2003
  43. Liao CW, Lin LY, Hung CS, Lin YT, Chang YY, Wang SM, et al. Time course and factors predicting arterial stiffness reversal in patients with aldosterone-producing adenoma after adrenalectomy: prospective study of 102 patients. Sci Rep 2016;6:20862. https://doi.org/10.1038/srep20862
  44. Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol 2018;6:51-9. https://doi.org/10.1016/S2213-8587(17)30367-4
  45. Satoh M, Kikuya M, Ohkubo T, Mori T, Metoki H, Hara A, et al. Aldosterone-to-renin ratio as a predictor of stroke under conditions of high sodium intake: the Ohasama study. Am J Hypertens 2012;25:777-83. https://doi.org/10.1038/ajh.2012.33
  46. Litchfield WR, Anderson BF, Weiss RJ, Lifton RP, Dluhy RG. Intracranial aneurysm and hemorrhagic stroke in glucocorticoid-remediable aldosteronism. Hypertension 1998;31(1 Pt 2):445-50. https://doi.org/10.1161/01.HYP.31.1.445
  47. Miyaji Y, Kawabata Y, Joki H, Seki S, Mori K, Kamide T, et al. Primary aldosteronism in patients with acute stroke: prevalence and diagnosis during initial hospitalization. BMC Neurol 2016;16:177. https://doi.org/10.1186/s12883-016-0701-5