Patients with primary aldosteronism (PA) are at increased cardiovascular risk, compared to patients with essential hypertension (EH). Cardiovascular damage could depend on PA phenotype, potentially being lower in milder forms of PA. Our aim was to assess atherosclerotic burden and arterial stiffness in 88 prospectively recruited patients, including 44 patients with mild PA and EH respectively. All patients underwent a structured study program, including measurements of ankle-brachial index, oscillometric measurement of central pulse wave velocity (cPWV) and vascular ultrasound examination of the supraaortic arteries, the abdominal aorta, and the femoropopliteal arteries. A plaque score was calculated to estimate atherosclerotic burden for each patient. This is a prospective case-control study set at a tertiary care hospital. Patients with PA and EH matched well for age, gender, blood pressure, BMI, and cardiovascular risk factors such as diabetes mellitus and smoking status. Common carotid intima-media thickness (0.77 vs. 0.75 mm; p=0.997) and cPWV (7.2 vs. 7.1 m/s; p=0.372) were comparable between patients with PA and EH. The atherosclerotic burden, as expressed by the plaque score, did not differ between the two groups (p=0.159). However, after initiation of treatment cPWV was significantly decreased in patients with PA (p=0.017). This study shows that subclinical atherosclerotic burden and arterial stiffness in patients with milder forms of PA is comparable to patients with EH. Nevertheless, specific treatment for PA significantly improved cPWV, which argues for a more liberal use of mineralocorticoid receptor antagonists in patients with arterial hypertension.

中文翻译：

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与原发性高血压患者相比，轻度原发性醛固酮增多症患者的动脉粥样硬化负担和动脉硬度没有增加

与原发性高血压 (EH) 患者相比，原发性醛固酮增多症 (PA) 患者的心血管风险增加。心血管损伤可能取决于 PA 表型，在较温和的 PA 形式中可能较低。我们的目的是评估 88 名前瞻性招募的患者的动脉粥样硬化负荷和动脉僵硬度，其中分别包括 44 名轻度 PA 和 EH 患者。所有患者都接受了结构化的研究计划，包括测量踝臂指数、中心脉搏波速度 (cPWV) 的示波测量和主动脉上动脉、腹主动脉和股腘动脉的血管超声检查。计算斑块评分以估计每位患者的动脉粥样硬化负担。这是一项在三级医院进行的前瞻性病例对照研究。PA 和 EH 患者的年龄、性别、血压、BMI 和心血管危险因素（如糖尿病和吸烟状况）匹配良好。PA 和 EH 患者的颈总动脉内中膜厚度（0.77 对 0.75 mm；p=0.997）和 cPWV（7.2 对 7.1 m/s；p=0.372）具有可比性。由斑块评分表示的动脉粥样硬化负担在两组之间没有差异（p = 0.159）。然而，在开始治疗后，PA 患者的 cPWV 显着降低（p=0.017）。该研究表明，轻度 PA 患者的亚临床动脉粥样硬化负荷和动脉僵硬度与 EH 患者相当。然而，针对 PA 的特定治疗显着改善了 cPWV，这表明在动脉高血压患者中更自由地使用盐皮质激素受体拮抗剂。