Circulating Plasma Concentrations of ACE2 in Primary Aldosteronism and Cardiovascular Outcomes

Abstract

Context: The plasma concentrations of angiotensin-converting enzyme 2 (pACE2) has been independently associated with cardiovascular diseases. Objective: Higher pACE2 concentrations may be found in patients with primary aldosteronism (PA) and might lead to increased cardiovascular events. Methods: Using an inception observational cohort, we examined pACE2 among 168 incident patients with PA. The expression of ACE2, serine protease 2 (TMPRSS2), and metalloprotease 17 (ADAM17) were assessed in peripheral blood mononuclear cells. Results: Incident PA and essential hypertension (EH) patients had similarly elevated pACE2 (47.04 ± 22.06 vs 46.73 ± 21.06 ng/mL; P =. 937). Age was negatively (β=-2.15; P =. 033) and higher serum potassium level (β=2.29; P =. 024) was positively correlated with higher pACE2 in PA patients. Clinical complete hypertension remission after adrenalectomy (Primary Aldosteronism Surgery Outcome criteria) was achieved in 36 (50%) of 72 surgically treated unilateral PA (uPA) patients. At follow-up, pACE2 decreased in surgically treated patients who had (P 23ng/mL) after targeted treatments was related to all-cause mortality and cardiovascular events among PA patients (hazard ratio=8.8; P =. 04); with a mean follow-up of 3.29 years. TMPRSS2 messenger RNA (mRNA) expression was higher in uPA (P =. 018) and EH (P =. 038) patients than in normotensive controls; it was also decreased after adrenalectomy (P 23 ng/mL) after targeted treatments was associated risk of mortality and incident cardiovascular events.