G-016 REVERSAL OF CAROTID INTIMA-MEDIA THICKNESS AND ARTERIAL STIFFNESS IN PATIENTS WITH ALDOSTERONE PRODUCING ADENOMA RECEIVING ADRENALECTOMY

Background Primary aldosteronism (PA) is the most frequent cause of secondary hypertension, and is associated with more prominent vascular stiffness and atherosclerosis. Current studies have implied that access aldosterone induced by PA could lead to increase vascular stiffness and carotid intima media thickness (CIMT). Though aldosterone producing adenoma (APA) is the most common subtype that can be cured by adrenalectomy, the post-surgical vascular changes remains unclear. Method We prospectively analyzed 20 patients with APA that received adrenalectomy from October 2006 to Dec 2008and 21 patients with essential hypertension (EH) were enrolled as the control group. CIMT measurement by B-mode ultrasound of the distal right common carotid arteries and pulse wave velocity (PWV) measurement including brachial-ankle PWV (baPWV) and heart-ankle PWV (haPWV) were performed in both groups. The follow-up measurements were performed one year after adrenalectomy in APA group. Results APA patients had significantly higher diastolic blood pressure, plasma aldosterone concentration (PAC) and aldosterone-renin ratio (ARR), but lower serum potassium level and plasma renin activity (PRA) than EH patients.APA patients had significantly higher CIMT, greater baPWV and haPWVthan EH patients (both p < 0.05). One year afteradrenalectomy, CIMT and PWV level decreased significantly (0.64 ± 0.13 to 0.59 ± 0.14 mm for CIMT, 1589 ± 296 to 1463 ± 188 cm/s for baPWV, 1095 ± 150 to 1017 ± 109 cm/s for haPWV, all p < 0.05). Conclusion The results of this study showed that APA patients have higher degree of early atherosclerosis and vascular stiffness. More importantly, this study is the first human trial demonstrating that adrenalectomy not only corrects the high blood pressure and biochemical data but also reverse adverse vascular change in APA patients.