Evolution features of hypertensive patients with primary aldosteronism - Prospective Study

Background: Primary aldosteronism is the leading cause of secondary hypertension, the management of this disease requiring an interdisciplinary approach. Objectives: Evaluation of evolutionary features of patients with secondary hypertension and primary aldosteronism. Methodology: We have followed 26 patients diagnosed with secondary hypertension and primary aldosteronism, who were admitted consecutively to "C. I. Parhon" Endocrinology Institute between 2004-2009. Of the 26 patients, 17 had adenoma producer of aldosterone (APA), 8 had bilateral adrenal hyperplasia idiopathic (HIA) and one patient had adrenal carcinoma (with hypersecretion of aldosterone). The mean age of the cohort was of 49.3 years (44.9 years for adenomas and 52.6 years for bilateral hyperplasia). The evaluation of the patients included clinical examination, electrocardiogram, Holter BP, echocardiography and determination of plasma aldosterone and renin. Results: The evolution of the patients with primary aldosteronism was different depending on the anatomoclinic type. In patients with idiopathic bilateral hyperplasia, medical treatment has improved control of hypertension and cardiac and cerebrovascular complications rate was moderate. In patients with unilateral adenoma producing aldosterone, blood pressure had higher values and more frequent complications, but surgical cure of adenomas significantly changed the prognosis of patients. In both cases, the presence of hypokalemia was an additional element of severity. Conclusions: Regardless of the primary aldosteronism, hypertension was directly involved in cardiac and cerebrovascular complications. Individualization of treatment according to the anatomoclinic type determined a significant improvement of the patients’ prognosis.