NEW YORK (Reuters Health) - Independent of blood pressure, patients with primary aldosteronism are at increased risk for cardiovascular events compared with patients with essential hypertension, new research shows.

In addition to hypertension, primary aldosteronism involves hypokalemia and low plasma renin. Previous reports have suggested that pressure-independent remodeling of the left ventricle may occur with primary aldosteronism, and yet there as been a paucity of cardiac complications linked to the condition.

To determine if primary aldosteronism increases the risk of cardiovascular events, Dr. Michel E. Safer, from Centre de Diagnostic, Hotel-Dieu, Paris, and colleagues analyzed data from 124 patients diagnosed with primary aldosteronism during a 3-year period and 465 matched subjects with essential hypertension. The patients included 65 with adenomas and 59 with idiopathic hyperaldosteronism.

The authors' findings are published in the April 19th issue of the Journal of the American College of Cardiology.

Nearly 13% of primary aldosteronism patients had experienced a stroke compared with 3.4% of essential hypertension patients, yielded odds ratio of 4.2, the investigators report. The corresponding rates for non-fatal MI were 4.0% and 0.6%, with an odds ratio of 6.5. Lastly, the rates of atrial fibrillation were 7.3% and 0.6% for an odds ratio of 12.1.

Further analysis showed that the risk of cardiovascular events was comparable regardless of the primary aldosteronism etiology, the investigators note.

The results suggest that "the presence of primary aldosteronism should be detected, not only to determine the cause of hypertension, but also to prevent" cardiovascular complications, Dr. Safer's team concludes.

In a related editorial, Dr. Gary S. Francis and Dr. W. H. Wilson Tang, from the Cleveland Clinic Foundation in Ohio, call the new findings "provocative, and these results point to potential benefits of aggressive screening for and prevention of hyperaldosteronism in patients at risk of developing cardiovascular diseases."

J Am Coll Cardiol 2005;45:1243-1250

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