Volume overload is a major characteristic in primary aldosteronism: a 3-year follow-up study

Eeva Kokko; Manoj Kumar Choudhary; Aapo Mutanen; Milja Honkonen; Antti Tikkakoski; Jenni K Koskela; Mari Hämäläinen; Eeva Moilanen; Marianna Viukari; Niina Matikainen; Pasi I Nevalainen; Ilkka Pörsti

doi:10.1097/HJH.0000000000003696

Volume overload is a major characteristic in primary aldosteronism: a 3-year follow-up study

Eeva Kokko, Manoj Kumar Choudhary, Aapo Mutanen, Milja Honkonen, Antti Tikkakoski, Jenni K Koskela, Mari Hämäläinen, Eeva Moilanen, Marianna Viukari, Niina Matikainen, Pasi I Nevalainen, Ilkka Pörsti

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Abstract

OBJECTIVES: We examined haemodynamics, focusing on volume balance and forward and backward wave amplitudes, before and after 2.8 years of targeted treatment of primary aldosteronism. Patients with essential hypertension and normotensive individuals were examined for comparison (n = 40 in each group).

METHODS: Recordings were performed using radial artery pulse wave analysis and whole-body impedance cardiography. Unilateral aldosteronism was treated with adrenalectomy (n = 20), bilateral aldosteronism with spironolactone-based medication (n = 20), and essential hypertension with standard antihypertensive agents.

RESULTS: Aortic SBP and DBP, forward and backward wave amplitudes, and systemic vascular resistance were equally elevated in primary aldosteronism and essential hypertension. All these haemodynamic variables were similarly reduced by the treatments. Primary aldosteronism presented with 1 litre (∼10%) extracellular water excess (P < 0.001) versus the other groups, and this excess was normalized by treatment. Initial pulse wave velocity (PWV) was similarly increased in primary aldosteronism and essential hypertension, but final values remained higher in primary aldosteronism (P < 0.001). In regression analyses, significant explanatory factors for treatment-induced forward wave amplitude reduction were decreased systemic vascular resistance (β = 0.380) and reduced extracellular water volume (β = 0.183). Explanatory factors for backward wave amplitude reduction were changes in forward wave amplitude (β = 0.599), heart rate (β = -0.427), and PWV (β = 0.252).

CONCLUSION: Compared with essential hypertension, the principal haemodynamic difference in primary aldosteronism was higher volume load. Volume excess elevated forward wave amplitude, which was subsequently reduced by targeted treatment of primary aldosteronism, along with normalization of volume load. We propose that incorporating extracellular water evaluation alongside routine diagnostics could enhance the identification and diagnosis of primary aldosteronism.

Original language	English
Pages (from-to)	1057-1065
Number of pages	9
Journal	Journal of Hypertension
Volume	42
Issue number	6
DOIs	https://doi.org/10.1097/HJH.0000000000003696
Publication status	Published - 1 Jun 2024
Publication type	A1 Journal article-refereed

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Kokko, E., Choudhary, M. K., Mutanen, A., Honkonen, M., Tikkakoski, A., Koskela, J. K., Hämäläinen, M., Moilanen, E., Viukari, M., Matikainen, N., Nevalainen, P. I., & Pörsti, I. (2024). Volume overload is a major characteristic in primary aldosteronism: a 3-year follow-up study. Journal of Hypertension, 42(6), 1057-1065. https://doi.org/10.1097/HJH.0000000000003696

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title = "Volume overload is a major characteristic in primary aldosteronism: a 3-year follow-up study",

abstract = "OBJECTIVES: We examined haemodynamics, focusing on volume balance and forward and backward wave amplitudes, before and after 2.8 years of targeted treatment of primary aldosteronism. Patients with essential hypertension and normotensive individuals were examined for comparison (n = 40 in each group).METHODS: Recordings were performed using radial artery pulse wave analysis and whole-body impedance cardiography. Unilateral aldosteronism was treated with adrenalectomy (n = 20), bilateral aldosteronism with spironolactone-based medication (n = 20), and essential hypertension with standard antihypertensive agents.RESULTS: Aortic SBP and DBP, forward and backward wave amplitudes, and systemic vascular resistance were equally elevated in primary aldosteronism and essential hypertension. All these haemodynamic variables were similarly reduced by the treatments. Primary aldosteronism presented with 1 litre (∼10%) extracellular water excess (P < 0.001) versus the other groups, and this excess was normalized by treatment. Initial pulse wave velocity (PWV) was similarly increased in primary aldosteronism and essential hypertension, but final values remained higher in primary aldosteronism (P < 0.001). In regression analyses, significant explanatory factors for treatment-induced forward wave amplitude reduction were decreased systemic vascular resistance (β = 0.380) and reduced extracellular water volume (β = 0.183). Explanatory factors for backward wave amplitude reduction were changes in forward wave amplitude (β = 0.599), heart rate (β = -0.427), and PWV (β = 0.252).CONCLUSION: Compared with essential hypertension, the principal haemodynamic difference in primary aldosteronism was higher volume load. Volume excess elevated forward wave amplitude, which was subsequently reduced by targeted treatment of primary aldosteronism, along with normalization of volume load. We propose that incorporating extracellular water evaluation alongside routine diagnostics could enhance the identification and diagnosis of primary aldosteronism.",

author = "Eeva Kokko and Choudhary, {Manoj Kumar} and Aapo Mutanen and Milja Honkonen and Antti Tikkakoski and Koskela, {Jenni K} and Mari H{\"a}m{\"a}l{\"a}inen and Eeva Moilanen and Marianna Viukari and Niina Matikainen and Nevalainen, {Pasi I} and Ilkka P{\"o}rsti",

note = "Copyright {\textcopyright} 2024 The Author(s). Published by Wolters Kluwer Health, Inc.",

year = "2024",

month = jun,

day = "1",

doi = "10.1097/HJH.0000000000003696",

language = "English",

volume = "42",

pages = "1057--1065",

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TY - JOUR

T1 - Volume overload is a major characteristic in primary aldosteronism

T2 - a 3-year follow-up study

AU - Kokko, Eeva

AU - Choudhary, Manoj Kumar

AU - Mutanen, Aapo

AU - Honkonen, Milja

AU - Tikkakoski, Antti

AU - Koskela, Jenni K

AU - Hämäläinen, Mari

AU - Moilanen, Eeva

AU - Viukari, Marianna

AU - Matikainen, Niina

AU - Nevalainen, Pasi I

AU - Pörsti, Ilkka

PY - 2024/6/1

Y1 - 2024/6/1

N2 - OBJECTIVES: We examined haemodynamics, focusing on volume balance and forward and backward wave amplitudes, before and after 2.8 years of targeted treatment of primary aldosteronism. Patients with essential hypertension and normotensive individuals were examined for comparison (n = 40 in each group).METHODS: Recordings were performed using radial artery pulse wave analysis and whole-body impedance cardiography. Unilateral aldosteronism was treated with adrenalectomy (n = 20), bilateral aldosteronism with spironolactone-based medication (n = 20), and essential hypertension with standard antihypertensive agents.RESULTS: Aortic SBP and DBP, forward and backward wave amplitudes, and systemic vascular resistance were equally elevated in primary aldosteronism and essential hypertension. All these haemodynamic variables were similarly reduced by the treatments. Primary aldosteronism presented with 1 litre (∼10%) extracellular water excess (P < 0.001) versus the other groups, and this excess was normalized by treatment. Initial pulse wave velocity (PWV) was similarly increased in primary aldosteronism and essential hypertension, but final values remained higher in primary aldosteronism (P < 0.001). In regression analyses, significant explanatory factors for treatment-induced forward wave amplitude reduction were decreased systemic vascular resistance (β = 0.380) and reduced extracellular water volume (β = 0.183). Explanatory factors for backward wave amplitude reduction were changes in forward wave amplitude (β = 0.599), heart rate (β = -0.427), and PWV (β = 0.252).CONCLUSION: Compared with essential hypertension, the principal haemodynamic difference in primary aldosteronism was higher volume load. Volume excess elevated forward wave amplitude, which was subsequently reduced by targeted treatment of primary aldosteronism, along with normalization of volume load. We propose that incorporating extracellular water evaluation alongside routine diagnostics could enhance the identification and diagnosis of primary aldosteronism.

AB - OBJECTIVES: We examined haemodynamics, focusing on volume balance and forward and backward wave amplitudes, before and after 2.8 years of targeted treatment of primary aldosteronism. Patients with essential hypertension and normotensive individuals were examined for comparison (n = 40 in each group).METHODS: Recordings were performed using radial artery pulse wave analysis and whole-body impedance cardiography. Unilateral aldosteronism was treated with adrenalectomy (n = 20), bilateral aldosteronism with spironolactone-based medication (n = 20), and essential hypertension with standard antihypertensive agents.RESULTS: Aortic SBP and DBP, forward and backward wave amplitudes, and systemic vascular resistance were equally elevated in primary aldosteronism and essential hypertension. All these haemodynamic variables were similarly reduced by the treatments. Primary aldosteronism presented with 1 litre (∼10%) extracellular water excess (P < 0.001) versus the other groups, and this excess was normalized by treatment. Initial pulse wave velocity (PWV) was similarly increased in primary aldosteronism and essential hypertension, but final values remained higher in primary aldosteronism (P < 0.001). In regression analyses, significant explanatory factors for treatment-induced forward wave amplitude reduction were decreased systemic vascular resistance (β = 0.380) and reduced extracellular water volume (β = 0.183). Explanatory factors for backward wave amplitude reduction were changes in forward wave amplitude (β = 0.599), heart rate (β = -0.427), and PWV (β = 0.252).CONCLUSION: Compared with essential hypertension, the principal haemodynamic difference in primary aldosteronism was higher volume load. Volume excess elevated forward wave amplitude, which was subsequently reduced by targeted treatment of primary aldosteronism, along with normalization of volume load. We propose that incorporating extracellular water evaluation alongside routine diagnostics could enhance the identification and diagnosis of primary aldosteronism.

U2 - 10.1097/HJH.0000000000003696

DO - 10.1097/HJH.0000000000003696

M3 - Article

C2 - 38406920

SN - 0263-6352

VL - 42

SP - 1057

EP - 1065

JO - Journal of Hypertension

JF - Journal of Hypertension

IS - 6

ER -

Volume overload is a major characteristic in primary aldosteronism: a 3-year follow-up study

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