Supplemental Digital Content is available in the text. Left ventricular hypertrophy (LVH) is often seen in patients with primary aldosteronism (PA), and the prevalence of LVH is reportedly higher among patients with PA than patients with essential hypertension. However, the correlation between aldosterone levels and LVH is undefined, and how aldosterone affects LVH in patients with PA remains unclear. We, therefore, retrospectively assessed a large PA database established by the multicenter JPAS (Japan Primary Aldosteronism Study) to reveal the factors associated with LVH in patients with PA without suspected autonomous cortisol secretion. In the 1186 patients with PA studied, the basal plasma aldosterone concentration, plasma renin activity, and the aldosterone-to-renin ratio did not significantly correlate with left ventricular LV mass index (LVMI) in single or multiple regression analyses. However, the plasma aldosterone concentration after the captopril challenge test or saline-infusion test, which are associated with autonomous aldosterone secretion, correlated significantly with LVMI, even after adjusting for patients’ backgrounds, including age and blood pressure. In addition, hypokalemia and the unilateral subtype also correlated with LVMI. Longitudinal subanalysis of medically or surgically treated patients with PA showed significant reductions in LVMI in both the surgery (63.0±18.1 to 55.3±19.5 g/m2.7, P<0.001) and drug treatment (56.8±14.1 to 52.1±13.5 g/m2.7, P<0.001) groups. Our results suggest the autonomous aldosterone secretion level, not the basal aldosterone level itself, is relevant to LVH in patients with PA. In addition, the elevated LVMI seen in patients with PA is at least partially reversible with surgical or medical treatment.

中文翻译：

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确认性试验后的最低点醛固酮水平与原发性醛固酮增多症的左心室肥大相关

补充数字内容在文本中可用。左心室肥厚（LVH）常见于原发性醛固酮增多症（PA）患者，据报道，PA患者左心室肥厚的患病率高于原发性高血压患者。然而，醛固酮水平与 LVH 之间的相关性尚不明确，而且醛固酮如何影响 PA 患者的 LVH 尚不清楚。因此，我们回顾性评估了由多中心 JPAS（日本原发性醛固酮增多症研究）建立的大型 PA 数据库，以揭示与没有疑似自主皮质醇分泌的 PA 患者 LVH 相关的因素。在研究的 1186 名 PA 患者中，基础血浆醛固酮浓度、血浆肾素活性、在单一或多元回归分析中，醛固酮与肾素的比率与左心室 LV 质量指数 (LVMI) 没有显着相关性。然而，与自主醛固酮分泌相关的卡托普利激发试验或盐水输注试验后的血浆醛固酮浓度与 LVMI 显着相关，即使在调整了患者的背景（包括年龄和血压）之后也是如此。此外，低钾血症和单侧亚型也与 LVMI 相关。对药物或手术治疗的 PA 患者的纵向亚组分析显示，手术（63.0±18.1 至 55.3±19.5 g/m2.7，P<0.001）和药物治疗（56.8±14.1 至 52.1±13.5 g/ m2.7, P<0.001) 组。我们的结果表明自主醛固酮分泌水平，不是基础醛固酮水平本身，与 PA 患者的 LVH 相关。此外，在 PA 患者中看到的 LVMI 升高至少可以通过手术或药物治疗部分逆转。