[Characteristics of cardiovascular and cerebrovascular diseases in patients with primary aldosteronism: a propensity score matching study].

Abstract

Objective: To analyze the characteristics of cardiovascular and cerebrovascular diseases in patients with primary aldosteronism (PA) and compare them with age-, sex-, and blood pressure-matched patients with essential hypertension (EH). Methods: This cross-sectional study was conducted at the West China Hospital of Sichuan University. Patients with PA and EH between December 2018 and December 2021 were included. Demographic characteristics, stroke events, coronary artery diseases, peripheral vascular diseases, and cardiac structure and function indicators were analyzed. Propensity score matching (PSM) was used to balance non-study data. The t-test, chi-square test, and Wilcoxon signed-rank test were used for data comparison. The cardiovascular and cerebrovascular damage in the patients with unilateral and bilateral PA were also compared. Results: A total of 336 and 369 patients with PA and EH, respectively, were enrolled in this study. One hundred and ninety-eight patients from each group were included after PSM; no significant differences were found in terms of age, gender, and blood pressure. The prevalence of stroke in the PA group was considerably higher than that in the EH group [12.6% (25/198) vs. 5.6% (11/198), P=0.014], due to the significantly greater risk of ischemic stroke [10.0% (20/198) vs. 4.5% (9/198), P=0.029]. The prevalence of hemorrhagic stroke, coronary artery disease, peripheral arterial stenosis, aorta atherosclerosis, and aneurysm in the PA group were also higher than those in the EH group, but there was no statistical significance (all P>0.05). More patients with PA had concurrent left ventricular hypertrophy [22.2% (44/198) vs. 9.1% (18/198)], left atrial enlargement [40.4% (80/198) vs. 30.3% (60/198)], ventricular septal thickening [50.0% (99/198) vs. 36.9% (73/198)], and aortic widening [21.7% (43/198) vs. 13.1% (26/198)] than those with EH (all P<0.05). Compared with the bilateral PA group, the unilateral PA group had higher prevalence of left ventricular hypertrophy [28.3% (51/180) vs. 13.4% (11/82), P=0.013]. Conclusions: Compared with well-matched patients with EH, patients with PA have significantly higher risks of cardiovascular and cerebrovascular diseases, which are mainly manifested in increased prevalence of stroke and severe damage to the cardiac structure. Patients with unilateral PA may suffer more severe cardiac damage than those with bilateral PA.