Primary aldosteronism and essential hypertension: Assessment of cardiovascular risk at diagnosis and after treatment F. Turchi a,b , V. Ronconi a , V. di Tizio a , L. Ceccoli a , M. Boscaro a , G. Giacchetti a, * a Division of Endocrinology, Università Politecnica delle Marche, Ospedali Riuniti “Umberto I-G.M. Lancisi-G.Salesi”, Via Conca 71, Ancona 60126, Italy b Department of Diabetology and Endocrinology, Asur Marche Area Vasta 1, S. Maria della Misericordia Hospital, Urbino, Italy Received 20 February 2013; received in revised form 26 August 2013; accepted 23 September 2013 Available online 2 November 2013 KEYWORDS Cardiovascular risk; Primary aldosteronism; Adrenal gland Abstract Background and aims: Primary aldosteronism (PA), the most frequent form of second- ary hypertension, is characterized by a higher rate of cardiovascular (CV) events than essential hypertension (EH). Aim of the study was to evaluate the cardiovascular risk according to the ESH/ESC 2007 guide- lines, in patients with PA and with EH, at diagnosis and after treatment. Methods and results: We prospectively studied 102 PA patients (40 with aldosterone producing adenoma-APA and 62 with idiopathic hyperaldosteronism-IHA) and 132 essential hypertensives at basal and after surgical or medical treatment (mean follow-up period 44 months for PA and 42 months for EH). At baseline evaluation the stratification of CV risk was significantly different: the predominant risk category was the high CV risk (50% in total PA, 53% in PA matched for blood pressure values and 55% in EH), but the very high risk category was twice in PA than in EH patients (36% in total PA and 33% in matched PA vs.17% in EH, p < 0.05). The worse risk profile of PA was due to a high- er prevalence of glycemic alterations, metabolic syndrome and left ventricular hypertrophy (LVH) (p < 0.05). After adequate treatment, the CV risk was significantly reduced becoming comparable in PA and in EH patient due to a reduction of hypertension grading, prevalence of metabolic syndrome, hypertension persistence and LVH (p < 0.05). Conclusion: Patients with PA present a high CV risk, which is in part reversible after specific treat- ment, due both to the reduced blood pressure values and to the improvement of end-organ damage. ª 2013 Elsevier B.V. All rights reserved. Introduction High blood pressure represents the first cause of mortality in the general population worldwide. Among different forms of hypertension, primary aldosteronism (PA) is the most frequent affecting about 10% of all hypertensive pa- tients [1]. A large body of evidence shows that aldosterone excess promotes vascular, renal and cardiac damages and meta- bolic complications [2]. Moreover, clinical studies have shown that PA is associated with an increased risk of cardiovascular (CV) and cerebrovascular diseases, far beyond blood pressure values [3]. Milliez and co-workers were the first to describe an increased rate of CV events in patients with PA compared with patients with essential hypertension (EH) [3]. Sub- sequently, a greater prevalence of coronary heart disease, cerebrovascular events and sustained arrhythmias was confirmed in patients with PA [4,5] but it could be reversed by surgical or pharmacological treatments [4]. Acronyms: PA, primary aldosteronism; EH, essential hypertension; CV, cardiovascular; APA, aldosterone producing adenoma; IHA, idiopathic hyperaldosteronism. * Corresponding author. Tel./fax: þ39 (0) 715964417. E-mail address: g.giacchetti@ospedaliriuniti.marche.it (G. Giacchetti). 0939-4753/$ - see front matter ª 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.numecd.2013.09.009 Nutrition, Metabolism & Cardiovascular Diseases (2014) 24, 476e482 Available online at www.sciencedirect.com Nutrition, Metabolism & Cardiovascular Diseases journal homepage: www.elsevier.com/locate/nmcd