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primary aldosteronism

Wojciech Kosmala, Aleksandra Rojek, Monika Przewlocka-Kosmala, Leah Wright, Andrzej Mysiak, Thomas H Marwick
BACKGROUND: Impaired functional capacity is a hallmark of patients with heart failure with preserved ejection fraction (HFpEF). Despite the association of HFpEF with reduced myocardial compliance attributed to fibrosis, spironolactone has not been shown to alter outcomes-perhaps reflecting the heterogeneity of underlying pathological mechanisms. OBJECTIVES: The authors sought to identify improvement in exercise capacity with spironolactone in the subset of patients with HFpEF with exercise-induced increase in ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e') reflecting elevation of left ventricular (LV) filling pressure...
October 25, 2016: Journal of the American College of Cardiology
Nathan Elie Frenk, Fernando Sebastianes, Antonio Marcondes Lerario, Maria Candida Barisson Villares Fragoso, Berenice Bilharinho Mendonca, Marcos Roberto de Menezes
OBJECTIVES: To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyperfunctioning adrenal disorders. METHOD: We retrospectively evaluated the long-term results of nine patients treated with computed tomography-guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macronodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment...
October 1, 2016: Clinics
Jamie L Benham, Maysoon Eldoma, Bushra Khokhar, Derek J Roberts, Doreen M Rabi, Gregory A Kline
Unilateral primary aldosteronism (PA) is often treated with adrenalectomy, but hypertension resolution rates are variable. A valid estimate of the postoperative normotension rate is necessary to inform the utility of PA testing and treatment. The authors searched MEDLINE In-Process & Other Non-Indexed Citations, Embase, and Cochrane Central Register of Controlled Trials. Prospective adult cohort studies with surgically treated PA that reported resolution of hypertension without the aid of medications were included...
October 19, 2016: Journal of Clinical Hypertension
Decio Armanini, Chiara Sabbadin, Alessandra Andrisani, Guido Ambrosini, Luciana Bordin
No abstract text is available yet for this article.
October 19, 2016: Journal of Clinical Hypertension
Do Hee Kim, Hee Jin Kwon, Sang A Ji, Hye Ryoun Jang, Sin-Ho Jung, Jung-Han Kim, Jae Hyeon Kim, Jung Eun Lee, Wooseong Huh, Yoon-Goo Kim, Dae Joong Kim, Ha Young Oh
Primary aldosteronism (PA) may induce significant decline of renal function and structural damage of kidney. However, it is difficult to evaluate accurate renal function in patients with PA, because glomerular hyperfiltration and aldosterone escape can conceal renal impairment. In this retrospective cohort study, we compared changes in renal function after unilateral adrenalectomy between patients with PA and patients with other adrenal diseases. Risk factors associated with postoperative renal impairment in patients with PA were analyzed...
July 2016: Medicine (Baltimore)
Christian Cadeddu, Valentina Mercurio, Paolo Spallarossa, Savina Nodari, Marco Triggiani, Ines Monte, Roberta Piras, Rosalinda Madonna, Pasquale Pagliaro, Carlo G Tocchetti, Giuseppe Mercuro
Because of the recent advances in chemotherapeutic protocols, cancer survival has improved significantly, although cardiovascular disease has become a major cause of morbidity and mortality among cancer survivors: in addition to the well-known cardiotoxicity (CTX) from anthracyclines, biologic drugs that target molecules that are active in cancer biology also interfere with cardiovascular homeostasis.Pharmacological and non-pharmacological strategies to protect the cardiovascular structure and function are the best approaches to reducing the prevalence of cardiomyopathy linked to anticancer drugs...
May 2016: Journal of Cardiovascular Medicine
Elena Azizan, Norlela Sukor, Nor Azmi Kamaruddin, A Rahman A Jamal, Jiri Ceral, Miroslav Solar, Isa Mohamed Rose, Geok Chin Tan
OBJECTIVE: Aldosterone-producing adenoma (APA) is a common curable cause of hypertension. Somatic mutations in five genes (KCNJ5, ATP1A1, ATP2B3, CACNA1D, and CTNNB1) have been found to cause the excess aldosterone production of two thirds of APAs [1-4]. KCNJ5 mutant APAs, the most common and largest, had explicit genotype-phenotype relationship - a low protein expression of KCNJ5 relative to their peritumoural zona glomerulosa (ZG) and a zona fasciculata-like composition [5-6]. Conversely for the other genes, controversy arises on whether they have the opposite cell phenotype [4,7-8]...
September 2016: Journal of Hypertension
Jun Tao
OBJECTIVE: Hyperaldosteronemia exerts adverse effects on vascular endothelium except enhanceing blood pressure; however, the impacts and molecular mechanisms of hyperaldosteronemia on endothelial progenitor cell (EPC)-mediated endothelial repair are yet to be determined. The aim of this study was to investigate the endothelial repair capacity of EPCs from hypertensive patients with primary hyperaldosteronemia (PHA). DESIGN AND METHOD: In vivo endothelial repair capacity of EPCs from PHAs (n = 20), age- and blood pressure-matched essential hypertension patients (n = 20), and age-matched healthy subjects (n = 20) was evaluated by transplantation into nude mice with carotid artery denudation injury...
September 2016: Journal of Hypertension
Giuseppe Maiolino, Alberto Flego, Gian Paolo Rossi
OBJECTIVE: PA causes excess cardiovascular (CV) damage, but whether it worsens prognosis remained uncertain as there are no prospective studies. To compare long-term outcome of the 1125 patients recruited in the PAPY study. DESIGN AND METHOD: 11.2% of the PAPY study patients had PA: 6.4% idiopathic hyperaldosteronism (IHA) received medical therapy; 4,8% aldosterone-producing adenoma (APA) required adrenalectomy. Endpoints were total and CV mortality, major adverse cardiovascular events (MACE) and total CV events...
September 2016: Journal of Hypertension
Martin Wolley, Ashraf Ahmed, Richard Gordon, Michael Stowasser
OBJECTIVE: Adrenal vein sampling (AVS) is vital for determining treatment options for primary aldosteronism (PA), but is a difficult procedure. Adrenocorticotropic hormone (ACTH) infusion or bolus has been reported to improve AVS success rates by increasing cortisol secretion, but effects on aldosterone and thus lateralisation are controversial. We therefore aimed to determine the effects of ACTH on AVS in regard to success rates and lateralization. DESIGN AND METHOD: AVS was performed in the morning after overnight recumbency in patients with PA confirmed by fludrocortisone suppression testing...
September 2016: Journal of Hypertension
Xiongjing Jiang, Hui Dong, Meng Peng, Yubao Zou, Wuqiang Che
OBJECTIVE: Adrenal venous sampling (AVS) is recommended by clinical guidelines to distinguish surgically curable types of primary aldosteronism, but remains widespread underused mainly due to difficulty in successful sampling. When considering that the right adrenal vein is angled caudally, AVS through upper extremity approach may be more appropriate. The purpose of this study was to establish the technique ofAVS via median cubital vein (MCV), and evaluate its safety and feasibility. DESIGN AND METHOD: From January 2012 to June 2015, 194 consecutive patients diagnosed as primary aldosteronism underwent AVS via MCV at the Fuwai Hospital...
September 2016: Journal of Hypertension
Jianzhong Xu, Qian Ge, Jin Zhang, Limin Zhu, Xiaofeng Tang, Hu Yarong, Yan Kong, Pinjing Gao, Jiguang Wang
OBJECTIVE: Primary aldosteronism (PA) represents the most common cause of secondary hypertension. A higher risk of cardiovascular events has been reported in patients with PA than in otherwise similar patients with essential hypertension (EH). So far, only a few studies investigated the levels of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in PA patients compared to EH patients. DESIGN AND METHOD: We studied 385 consecutive patients with PA and 385 with EH individually matched for age, gender, body mass index (BMI), blood pressure values and duration of hypertension...
September 2016: Journal of Hypertension
Marko Poglitsch, Ashraf H Ahmed, Andrea Stoller, Dunja Van Oyen, Cornelia Schwager, Claudia Aigner, Oliver Domenig, Manuel Haschke, Michael Stowasser
OBJECTIVE: Primary aldosteronism (PA) is a widely under-diagnosed, potentially curable and specifically treatable cause of hypertension. PA screening involves measuring the aldosterone-to-renin-ratio (ARR), but false negative results can occur in the setting of medications, which block the renin-angiotensin system (RAS). Withdrawing RAS blockers from patients with resistant hypertension is not without cardiovascular risk. A novel diagnostic approach, the aldosterone-to-angiotensin-II-ratio (AA2-Ratio), has the potential for less drug interference and improved reliability in PA screening and confirmation of diagnosis...
September 2016: Journal of Hypertension
Marko Poglitsch, Ashraf H Ahmed, Michael Resl, Andrea Stoller, Dunja Van Oyen, Cornelia Schwager, Claudia Aigner, Oliver Domenig, Michael Krebs, Manuel Haschke, Michael Stowasser
OBJECTIVE: Primary aldosteronism (PA) is form of hypertension characterized by production of aldosterone by the adrenal that is excessive and relatively autonomous of the renin-angiotensin system. Once detected, unilateral PA can be usually cured by surgical removal of the affected adrenal, while bilateral PA can be specifically treated by medications, which antagonize aldosterone action. Clinical guidelines of Endocrine Societies in Europe and the US recommend screening for PA among most hypertensive patients...
September 2016: Journal of Hypertension
Leonardo Sechi, GIanLuca Colussi, Marileda Novello, Cristiana Catena
OBJECTIVE: Primary aldosteronism is associated with increased left ventricular mass independent of blood pressure levels. Previous studies suggest that elevated aldosterone causes cardiac damage only in the presence of an inappropriate salt status. We examined the relevance of dietary salt intake on cardiac changes in patients with primary aldosteronism before and after treatment. DESIGN AND METHOD: Sixty-five patients with tumoral or idiopathic primary aldosteronism were recruited at a University medical center and followed after either surgical (n = 30) or medical (n = 35) treatment...
September 2016: Journal of Hypertension
Yen-Hung Lin, Chi-Sheng Hung, Chia-Hung Chou, Vin-Cent Wu, Che-Wei Liao, Yi-Yao Chang, Xue-Ming Wu, Kwan-Dun Wu
OBJECTIVE: High dietary salt and high aldosterone levels may be deleterious to cardiac structure in patients with primary aldosteronism (PA) in samll studies. However the relation among them still unclear. We investigated the association among dietary sodium intake, aldosterone levela and cardiac structure in patients with PA and essential hypertension (EH). DESIGN AND METHOD: This cross-sectional study enrolled 158 patients with confirmed PA and 158 patients with EH...
September 2016: Journal of Hypertension
Yoshikiyo Ono, Yoshitsugu Iwakura, Ryo Morimoto, Masataka Kudo, Yasuhiro Igarashi, Masahiro Nezu, Yuta Tezuka, Hiromasa Ogawa, Sadayoshi Ito, Fumitoshi Stash
OBJECTIVE: Primary aldosteronism (PA) and sleep apnea syndrome (SAS) are common form of secondary hypertension. Some papers reported the group of high risk of SAS was higher rate of complication with PA than that of low risk of SAS. However, there are few reports which evaluated CPAP implementation rate of the PA patients with SAS diagnosing by Polysomnography (PSG). We aim to clarify clinical characteristics of patients of PA with SAS. DESIGN AND METHOD: We screened with Apnomonitor 284 PA patients who underwent adrenal venous sampling (AVS)...
September 2016: Journal of Hypertension
Martin Wolley, Diane Cowley, Ashraf Ahmed, Richard Gordon, Michael Stowasser
OBJECTIVE: Obstructive sleep apnoea (OSA) is known to commonly co-exist with primary aldosteronism (PA), but it is unknown if treatment via mineralocorticoid receptor blockade or adrenalectomy (for aldosterone producing adenoma, APA), improves sleep apnoea parameters in these patients. We therefore aimed to determine if specific medical or surgical treatment of PA improves OSA, as measured by the apnoea hypopnoea index (AHI). DESIGN AND METHOD: Patients undergoing diagnostic workup for PA were recruited if they had symptoms suggestive of OSA...
September 2016: Journal of Hypertension
Marko Poglitsch
Primary aldosteronism (PA) is severe form of hypertension characterized by a strongly increased aldosterone secretion mediated by adenomas or other forms of adrenal hyper-activity. Once detected, PA can be usually cured by either surgical intervention or by appropriate pharmacologic treatments. The incidence of PA among hypertensive patients varies strongly between different studies, which is in part caused by the complex state-of-the-art testing procedure that is unfortunately far away from being a versatile PA screening tool...
September 2016: Journal of Hypertension
Gian Paolo Rossi
Primary aldosteronism (PA) involves more than 11% of patients referred to specialized hypertension centers and, therefore, is much more common than commonly held. Moreover, it causes a damage to the heart, blood vessels and kidneys, which translates into a high rate of cardiovascular events, in excess to the degree of blood pressure raise. Along with the notion that a timely diagnosis entails a fundamental step for the choice of an appropriate therapy, which can correct the arterial hypertension and the hypokalemia, this justifies efforts to search for PA in the majority of the patients with hypertension...
September 2016: Journal of Hypertension
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