P.097 Adrenalectomy is More Effective than Spironolactone in Reducing Arterial Stiffness in Primary Aldosteronism

Abstract

Objective

The study was aimed at assessment of the effects of specific treatment of primary aldosteronism (PA) on the arterial stiffness.

Design and Methods

28 patients with confirmed PA (14 with aldosterone-producing adenoma treated by unilateral laparoscopic adrenalectomy, 14 with idiopathic hyperaldosteronism (treated with spironolactone) were investigated by Sphygmocor applanation tonometer using measurement of pulse wave velocity (PWV) and augmentation index (AI) at the time of the diagnosis and then again 1 year after the specific treatment.

Results

The mean 24h-BP levels decreased from 149 ± 18/92 ± 11mmHg to 128 ± 15/81 ± 10mmHg (p<0,01) after adrenalectomy (p<0,01), and from 155 ± 16/94 ± 12 to 140 ± 18/88 ± 8mmHg (p<0,05; n.s.). on spironolactone. The PWV significantly decreased after surgery from 9,3 ± 3 na 7,6 ± 2,1 m/s (p = 0,002), also the AI decreased significantly from 25 ± 9 na 17 ± 8% p = 0,006. However, no significant improvement of the arterial stiffness indices was found in the patients treated with spironolactone (PWV before 9,3 ± 1,6, after 8,9 ± 1,3 m/s, n.s.; AI 24 ± 9.25 ± 8%, n.s.). After correction for differences in 24-h BP fall stays the AI fall more significant (p<0,01)in the surgically treated than spironolactone treated patients.

Conclusions

The causal surgical treatment of PA is significantly more effective in improving arterial stiffness than conservative treatment with spironolactone, also after correction for 24-h BP difference. This could indicate a possibility, that the aldosterone receptor blockade by spironolactone doesn’t fully prevent arterial wall damage mediated by aldosterone, and that nongenomic aldosterone effects could possibly play a role in patophysiology of arterial wall damage.