Prediction of vascular injury and the impact of physical activity on the association between Primary ALdosteronism and cerebral Microbleeds (PALM)

Abstract Background Primary aldosteronism(PA) induces hypertension and vascular injury. Cerebral microbleed(CMB) is a representative form and can cause cognitive decline over the long term. This study is to investigate vascular damage in PA. Regarding physical activity, a preventive factor for vascular damage and known to increase aldosterone itself, we evaluated difference between aldosteronism and CMB depending on level of usual physical activity. Method We recruited PA diagnosed patients aged 13 years or older, who visited Endocrinology clinic in the past 3 years. We excluded patients with other causes of hypertension and major brain lesion. Brain magnetic resonance imaging(MRI), and physiological tests were performed: transcranial doppler(TCD), peak wave velocity(PWV), and sonographic endothelial function test(SEFT). In addition, we performed funduscopy for detecting retinal microhemorrhage, and Korean version of Montreal Cognitive Assessment(K‐MoCA), Clinical Dementia Rating(CDR), Clinical Dementia Rating sum of boxes(CDR‐SOB) for cognitive assessment. Physical activity was investigated using global physical activity questionnaire. Result Total 41 participants (age, 46.0±13.4years; 46.3% of male; BMI, 25.8±3.4kg/m 2 ; education, 13.8±2.2years) were enrolled. The mean duration of PA was 1.7±1.7years, and serum findings at diagnosis were as follows: renin (0.5±0.4ng/ml/hr), aldosterone concentration (318.6±203.3pg/mL), potassium (3.6±0.8mMol/L), aldosterone‐to‐renin ratio (91.5±73.7). In 30 of 41 patients, adrenal masses were observed on abdominal Computed Tomography(number, 1.3±0.6; size, 14.8±5.0mm). There were participants with vascular risk factors: hypertension(38, 8.1±6.4), diabetes mellitus(3, 2.5±1.8), and dyslipidemia(2, 7.7±5.8). 1 participant each had been diagnosed with myocardial infarction and cerebrovascular disease. 10 participants had a smoking history (7.8±12.3pack years), and 24 had a drinking history, with the average frequency of drinking per week was 1.2±1.4. Cognitive status was assessed by K‐MoCA(26.8±2.5), CDR(0.2±0.2) and CDRSOB(0.2±0.2). Moderate‐to‐vigorous physical activity was 192.2±246.7 minutes per week. CMB was confirmed in 10 and lacune in 7 cases. There were 9 participants who showed white matter change in Fazekas grade 1‐2. Physiological tests showed abnormality in 1 patient in TCD, 7 in PWV(baPWV, 14.1±1.9 m/s), and 6 in SEFT(flow mediated dilation, 6.6±1.3%). Conclusion It is expected that more data will be collected through additional participant recruitment and evaluation. It remains to be seen that the analysis with additional data will yield results to test the hypothesis.