Renin, a marker for left ventricular hypertrophy, in primary aldosteronism: A cohort study

Abstract

Context: Primary aldosteronism (PA) causes left ventricular hypertrophy (LVH) via hemodynamic factors and directly by aldosterone effects. Specific treatment by mineralocorticoid r eceptor antagonists (MRA) or adrenalectomy (ADX) has been reported to improve LVH. However, the cardiovascular b enefit could depend on plasma renin concentration (PRC) in patients on MRA. Patients and objective: We analyzed data from 184 patients from the Munich center of t he German Conn's Registry, who underwent echocardiography at the time of diagnosis and 1 y ear after treatment. To assess the effect of PRC on cardiac recovery, we stratified patients on MRA according to sup pression (n = 46) or non-suppression of PRC (n = 59) at follow-up and compared them to PA patients after ADX ( n = 79). Results: At baseline, patients treated by ADX or MRA had comparable left ventricular mass index (LVMI, 61.7 vs 58.9 g/m2.7, P = 0.591). Likewise, patients on MRA had similar LVMI at baseline , when stratified into treatment groups with suppressed and unsuppressed PRC during follow-up (60.0 vs 58.1 g/m2.7, P = 0.576). In all three groups, we observed a significant reduction in LVMI following treatment (P < 0.001). However, patients with suppressed PRC had no decrease in pro-BNP levels, and the reduction of LVMI was less intense t han in patients with unsuppressed PRC (4.1 vs 8.2 g/m2.7, P = 0.033) or after ADX (9.3 g/m2.7, P = 0.019). Similarly, in multivariate analysis, higher PRC was cor related with the regression of LVH. Conclusion: PA patients with suppressed PRC on MRA show impaired regressio n of LVH. Therefore, dosing of MRA according to PRC could improve their cardiovascular benefit. 2021 European Society of Endocrinology Printed in Great Britain.