HYPERTENSIVE COMPLICATIONS IN PATIENTS WITH PRIMARY ALDOSTERONISM - A RETROSPECTIVE STUDY

This study was conducted to clarify the incidence and risk profiles of hypertensive vascular complications in patients with primary aldosteronism. The subjects were 32 patients with primary aldosteronism (PA) who were admitted to the second Department of Internal Medicine at Yokohama City University Hospital over the past 17 years. Incidence of hypertensive vascular complications and the possible risk factors were retrospectively analyzed. Hypertensive vascular complications were found in 12 of 32 patients with PA. Cerebrovascular accidents developed in seven of the 12, and retinal hemorrhage was found in seven of these patients. Chronic renal failure with a component of nephrosclerosis was found in six of the 12 patients. The incidence of severe hypertension (diastolic blood pressure 130 mmHg or higher), severe hypertensive retinopathy (higher than or equal to grade 2 in Scheie's classification), and positive family history of stroke in first-degree relatives of the patients with PA with vascular complications as 75.0%, 66.7% and 41.7%, respectively, while the incidence was significantly lower (P < 0.05) in the patients without complications (35.0%, 15.0% and 10.0%, respectively). The endocrinologic and biochemical findings (plasma renin activity, plasma aldosterone concentration, serum potassium, fasting plasma glucose, total cholesterol, triglycerides, uric acid, and creatinine), hematocrit and size of aldosteronoma, age, body mass index, smoking status, and duration of known hypertension did not show significant differences between the patients with and without these complications. The hypertensive vascular complications occurred even under treatment with spironolactone. In conclusion, the incidence of hypertensive vascular events in PA is 62.5%. Higher diastolic blood pressure and a positive family history of stroke are identified as the contributing factors of hypertensive complications. Treatment with spironolactone may have no reliably preventive effect against the vascular complications in PA.