Association Of Plasma Aldosterone With Target Organ Damage In Primary Hypertension

Backgroud:At the same blood pressure level,target organ damage appears earlier and is more severe in patients with primary aldosteronism compared with primary hypertension,suggesting that aldosterone may have an independent role in causing target organ damage in hypertension,but it is unclear whether aldosterone is also an independent risk factor for target organ damage in hypertension in primary hypertension,especially with respect to the degree of atherosclerosis.There are fewer studies and inconsistent findings.Objective:The purpose of this study was to investigate the relationship between plasma aldosterone concentration and hypertensive target organ damage in PH,and to investigate the extent of aldosterone effect on brachial-ankle pulse wave conduction velocity and to develop a predictive model of brachial-ankle pulse wave conduction velocity and its simplified form.Methods:A total of 1337 patients who were admitted to the hypertension and heart failure unit of the First Affiliated Hospital of Dalian Medical University and diagnosed with primary hypertension from November 2016 to November 2022 were selected.The patients’ gender,age,body mass index,smoking history,alcohol consumption history,disease history,history of adequate drug elution before and current medication,direct renin concentration in the prone position,blood sodium,blood potassium,24 h urine sodium quantification,24 h urine potassium quantification,24 h ambulatory blood pressure monitoring index,indexes related to target organ damage in hypertension(e.g.,cardiac ultrasound index,urine microalbumin,urine albumin-creatinine ratio,and Brachial-ankle pulse wave velocity,FMD,carotid intima-media thickness,etc.).SPSS26.0 software was applied for data analysis.The 1337 patients were divided into three groups according to prone plasma aldosterone concentrations,and the differences in baseline information of blood pressure,heart,kidney,and blood vessels were compared among the three groups.The correlation between plasma aldosterone concentration and indicators related to target organ damage in hypertension was analyzed.Multiple linear regression was used to analyze whether prone PAC was independently correlated with TOD-related indexes.The brachial-ankle pulse wave conduction velocity was divided into non-atherosclerotic and atherosclerotic groups according to whether it was in the range of the atherosclerotic group.After converting the brachial-ankle pulse wave conduction velocity into a dichotomous variable,the meaningful variables were screened out by logistic regression analysis,and the Jorden index and best cut-off values of the above variables were obtained according to the ROC curve function.After converting the screened variables into dichotomous variables according to the best cutoff values,logistic regression analysis was performed to establish a prediction model for brachial-ankle pulse wave conduction velocity and to simplify it.Results:1.The higher blood pressure level,posterior left ventricular wall thickness,septal thickness,left ventricular mass index,urinary microalbumin,UACR,and 24 h urinary protein quantification;and the faster baPWV were found in the high supine PAC group compared with the low supine PAC group,with statistical differences between the three groups(all P values <0.05).2.Correlation analysis showed that supine PAC was positively correlated with IVST,LVPWT,LVMI,UmAlb,UACR,24 h urine protein quantification and baPWV(all P values <0.05).3.IVST,LVPWT,LVMI,UmAlb,UACR,24 h urine protein quantification and baPWV were independently correlated with prone PAC(all P values < 0.05).4.Four variables were included in the prediction model: age,all-day systolic blood pressure,prone PAC,and fasting glucose,and the AUC value of the prediction model was 0.794(95% CI(0.762,0.827)).According to the obtained model,the regression coefficients and the best cutoff values of the above variables were rounded to obtain a simplified form of the prediction model,in which age ≤ 52.00 years was assigned a value of 0 and age > 52.00 years was assigned a value of 2;all-day systolic blood pressure ≤ 154.00 mm Hg was assigned a value of 0 and all-day systolic blood pressure > 154.00 mm Hg was assigned a value of 2;prone PAC ≤ 100.00 pg/ml was assigned a value of 0 and prone PAC ≤ 100.00 pg/ml was assigned a value of 0.The AUC value of the simplified model was 0.785,and the best cut-off value was a score >3,which was used as the prediction basis for baPWV in the non-atherosclerotic group(≤3)and the atherosclerotic group(>3).Conclusion:1.In patients with primary hypertension,plasma ambulatory aldosterone levels are positively correlated with hypertensive target organ-related indicators.2.Plasma aldosterone is an independent risk factor for IVST,LVPWT,LVMI,UmAlb,UACR,24 h urine protein quantification and baPWV,which can provide a basis for predicting target organ damage in hypertension.3.In this study,we established a diagnostic model of baPWV in patients with primary hypertension and its simplified form,which contains four variables: age,all-day systolic blood pressure,prone PAC,and fasting blood glucose.The diagnostic ability of the model for baPWV is more advantageous than appsupine these three variables alone,and the variables are easily available and easy to use in primary hospitals,which has some reference value for the determination of the degree of atherosclerosis in this type of patients.