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Horm Metab Res 2015; 47(13): 973-980
DOI: 10.1055/s-0035-1565124
Review

Cardiovascular Risk in Primary Hyperaldosteronism

A. Prejbisz
1   Department of Hypertension, Institute of Cardiology, Warsaw, Poland
,
E. Warchoł-Celińska
1   Department of Hypertension, Institute of Cardiology, Warsaw, Poland
,
J. W. M. Lenders
2   Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
3   Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universitat Dresden, Dresden, Germany
,
A. Januszewicz
1   Department of Hypertension, Institute of Cardiology, Warsaw, Poland
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Abstract

After the first cases of primary aldosteronism were described and characterized by Conn, a substantial body of experimental and clinical evidence about the long-term effects of excess aldosterone on the cardiovascular system was gathered over the last 5 decades. The prevalence of primary aldosteronism varies considerably between different studies among hypertensive patients, depending on patient selection, the used diagnostic methods, and the severity of hypertension. Prevalence rates vary from 4.6 to 16.6% in those studies in which confirmatory tests to diagnose primary aldosteronism were used. There is also growing evidence indicating that prolonged exposure to elevated aldosterone concentrations is associated with target organ damage in the heart, kidney, and arterial wall, and high cardiovascular risk in patients with primary aldosteronism. Therefore, the aim of treatment should not be confined to BP normalization and hypokalemia correction, but rather should focus on restoring the deleterious effects of excess aldosterone on the cardiovascular system. Current evidence convincingly demonstrates that both surgical and medical treatment strategies beneficially affect cardiovascular outcomes and mortality in the long term. Further studies can be expected to provide better insight into the relationship between cardiovascular risk and complications and the genetic background of primary aldosteronism.

Key words

aldosterone - cardiovascular event - target organ damage - blood pressure


Publication History

Received: 20 August 2015

Accepted: 12 October 2015

Article published online:
17 November 2015

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Conn JW. Presidential address. I. Painting background. II. Primary aldosteronism, a new clinical syndrome. J Lab Clin Med 1955; 45: 3-17
    PubMedSearch in Google Scholar
  • 2 Kaplan NM, Victor RG. Primary aldosteronism. In: Kaplan NM, Victor RG (eds.). Kaplan’s clinical hypertension. Philadelphia: Wolters Kluwer; 2015: 320–340
  • 3 Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, Young Jr WF, Montori VM. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008; 93: 3266-3281
    CrossrefPubMedSearch in Google Scholar
  • 4 Connell JM, MacKenzie SM, Freel EM, Fraser R, Davies E. A lifetime of aldosterone excess: long-term consequences of altered regulation of aldosterone production for cardiovascular function. Endocr Rev 2008; 29: 133-154
    CrossrefPubMedSearch in Google Scholar
  • 5 Sechi LA, Colussi G, Di Fabio A, Catena C. Cardiovascular and renal damage in primary aldosteronism: outcomes after treatment. Am J Hypertens 2010; 23: 1253-1260
    CrossrefPubMedSearch in Google Scholar
  • 6 Blasi ER, Rocha R, Rudolph AE, Blomme EA, Polly ML, McMahon EG. Aldosterone/salt induces renal inflammation and fibrosis in hypertensive rats. Kidney Int 2003; 63: 1791-1800
    Search in Google Scholar
  • 7 Rocha R, Chander PN, Khanna K, Zuckerman A, Stier Jr CT. Mineralocorticoid blockade reduces vascular injury in stroke-prone hypertensive rats. Hypertension 1998; 31: 451-458
    CrossrefPubMedSearch in Google Scholar
  • 8 Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, Burnier M, Ambrosioni E, Caufield M, Coca A, Olsen MH, Tsioufis C, van de Borne P, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Ferrari R, Hasdai D, Hoes AW, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Clement DL, Gillebert TC, Rosei EA, Anker SD, Bauersachs J, Hitij JB, Caulfield M, De Buyzere M, De Geest S, Derumeaux GA, Erdine S, Farsang C, Funck-Brentano C, Gerc V, Germano G, Gielen S, Haller H, Jordan J, Kahan T, Komajda M, Lovic D, Mahrholdt H, Ostergren J, Parati G, Perk J, Polonia J, Popescu BA, Reiner Z, Ryden L, Sirenko Y, Stanton A, Struijker-Boudier H, Vlachopoulos C, Volpe M, Wood DA. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34: 2159-2219
    CrossrefPubMedSearch in Google Scholar
  • 9 Piaditis G, Markou A, Papanastasiou L, Androulakis II, Kaltsas G. Progress in aldosteronism: a review of the prevalence of primary aldosteronism in pre-hypertension and hypertension. Eur J Endocrinol 2015; 172: R191-R203
    CrossrefPubMedSearch in Google Scholar
  • 10 Rossi GP, Seccia TM, Pessina AC. Primary aldosteronism-part I: prevalence, screening, and selection of cases for adrenal vein sampling. J Nephrol 2008; 21: 447-454
    PubMedSearch in Google Scholar
  • 11 Calhoun DA. Is there an unrecognized epidemic of primary aldosteronism?. Pro. Hypertension 2007; 50: 447-453 discussion 447–453
    CrossrefPubMedSearch in Google Scholar
  • 12 Kaplan NM. Is there an unrecognized epidemic of primary aldosteronism?. Con. Hypertension 2007; 50: 454-458 discussion 454–458
    CrossrefPubMedSearch in Google Scholar
  • 13 Rossi GP. Prevalence and diagnosis of primary aldosteronism. Curr Hypertens Rep 2010; 12: 342-348
    CrossrefPubMedSearch in Google Scholar
  • 14 Mosso L, Carvajal C, Gonzalez A, Barraza A, Avila F, Montero J, Huete A, Gederlini A, Fardella CE. Primary aldosteronism and hypertensive disease. Hypertension 2003; 42: 161-165
    CrossrefPubMedSearch in Google Scholar
  • 15 Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, Ganzaroli C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Mattarello MJ, Moretti A, Palumbo G, Parenti G, Porteri E, Semplicini A, Rizzoni D, Rossi E, Boscaro M, Pessina AC, Mantero F. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol 2006; 48: 2293-2300
    CrossrefPubMedSearch in Google Scholar
  • 16 Douma S, Petidis K, Doumas M, Papaefthimiou P, Triantafyllou A, Kartali N, Papadopoulos N, Vogiatzis K, Zamboulis C. Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study. Lancet 2008; 371: 1921-1926
    CrossrefPubMedSearch in Google Scholar
  • 17 Florczak E, Prejbisz A, Szwench-Pietrasz E, Sliwinski P, Bielen P, Klisiewicz A, Michalowska I, Warchol E, Januszewicz M, Kala M, Witkowski A, Wiecek A, Narkiewicz K, Somers VK, Januszewicz A. Clinical characteristics of patients with resistant hypertension: the RESIST-POL study. J Hum Hypertens 2013; 27: 678-685
    CrossrefPubMedSearch in Google Scholar
  • 18 Fischer E, Reuschl S, Quinkler M, Rump LC, Hahner S, Bidlingmaier M, Reincke M. Assay characteristics influence the aldosterone to renin ratio as a screening tool for primary aldosteronism: results of the German Conn’s registry. Horm Metab Res 2013; 45: 526-531
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Pilz S, Kienreich K, Gaksch M, Grubler M, Verheyen N, Bersuch LA, Schmid J, Drechsler C, Ritz E, Moosbrugger A, Stepan V, Pieber TR, Meinitzer A, Marz W, Tomaschitz A. Aldosterone to active Renin ratio as screening test for primary aldosteronism: reproducibility and influence of orthostasis and salt loading. Horm Metab Res 2014; 46: 427-432
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Viola A, Monticone S, Burrello J, Buffolo F, Lucchiari M, Rabbia F, Williams TA, Veglio F, Mengozzi G, Mulatero P. Renin and aldosterone measurements in the management of arterial hypertension. Horm Metab Res 2015; 47: 418-426
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Tomaschitz A, Maerz W, Pilz S, Ritz E, Scharnagl H, Renner W, Boehm BO, Fahrleitner-Pammer A, Weihrauch G, Dobnig H. Aldosterone/renin ratio determines peripheral and central blood pressure values over a broad range. J Am Coll Cardiol 2010; 55: 2171-2180
    CrossrefPubMedSearch in Google Scholar
  • 22 Vasan RS, Evans JC, Larson MG, Wilson PW, Meigs JB, Rifai N, Benjamin EJ, Levy D. Serum aldosterone and the incidence of hypertension in nonhypertensive persons. N Engl J Med 2004; 351: 33-41
    CrossrefPubMedSearch in Google Scholar
  • 23 Mansoor GA, White WB. Circadian blood pressure variation in hypertensive patients with primary hyperaldosteronism. Hypertension 1998; 31: 843-847
    CrossrefPubMedSearch in Google Scholar
  • 24 Zelinka T, Widimsky J. Twenty-Four hour blood pressure profile in subjects with different subtypes of primary aldosteronism. Physiol Res 2001; 50: 51-57
    PubMedSearch in Google Scholar
  • 25 Ceruti M, Petramala L, Cotesta D, Cerci S, Serra V, Caliumi C, Iorio M, De Toma G, Ciardi A, Vitolo D, Letizia C. Ambulatory blood pressure monitoring in secondary arterial hypertension due to adrenal diseases. J Clin Hypertens (Greenwich) 2006; 8: 642-648
    CrossrefPubMedSearch in Google Scholar
  • 26 Pimenta E, Gaddam KK, Pratt-Ubunama MN, Nishizaka MK, Cofield SS, Oparil S, Calhoun DA. Aldosterone excess and resistance to 24-h blood pressure control. J Hypertens 2007; 25: 2131-2137
    CrossrefPubMedSearch in Google Scholar
  • 27 Muth A, Ragnarsson O, Johannsson G, Wangberg B. Systematic review of surgery and outcomes in patients with primary aldosteronism. Br J Surg 2015; 102: 307-317
    CrossrefPubMedSearch in Google Scholar
  • 28 van der Linden P, Steichen O, Zinzindohoue F, Plouin PF. Blood pressure and medication changes following adrenalectomy for unilateral primary aldosteronism: a follow-up study. J Hypertens 2012; 30: 761-769
    CrossrefPubMedSearch in Google Scholar
  • 29 Rossi GP. Cardiac consequences of aldosterone excess in human hypertension. Am J Hypertens 2006; 19: 10-12
    CrossrefPubMedSearch in Google Scholar
  • 30 Catena C, Colussi G, Marzano L, Sechi LA. Aldosterone and the heart: from basic research to clinical evidence. Horm Metab Res 2012; 44: 181-187
    Thieme ConnectPubMedSearch in Google Scholar
  • 31 Catena C, Colussi GL, Marzano L, Sechi LA. Predictive factors of left ventricular mass changes after treatment of primary aldosteronism. Horm Metab Res 2012; 44: 188-193
    Thieme ConnectPubMedSearch in Google Scholar
  • 32 Milan A, Magnino C, Fabbri A, Chiarlo M, Bruno G, Losano I, Veglio F. Left heart morphology and function in primary aldosteronism. High Blood Press Cardiovasc Prev 2012; 19: 11-17
    CrossrefPubMedSearch in Google Scholar
  • 33 Muiesan ML, Salvetti M, Paini A, Agabiti-Rosei C, Monteduro C, Galbassini G, Belotti E, Aggiusti C, Rizzoni D, Castellano M, Agabiti-Rosei E. Inappropriate left ventricular mass in patients with primary aldosteronism. Hypertension 2008; 52: 529-534
    CrossrefPubMedSearch in Google Scholar
  • 34 Indra T, Holaj R, Zelinka T, Petrak O, Strauch B, Rosa J, Somloova Z, Malik J, Janota T, Hradec J, Widimsky Jr J. Left ventricle remodeling in men with moderate to severe volume-dependent hypertension. J Renin Angiotensin Aldosterone Syst 2012; 13: 426-434
    CrossrefPubMedSearch in Google Scholar
  • 35 Pimenta E, Gordon RD, Ahmed AH, Cowley D, Leano R, Marwick TH, Stowasser M. Cardiac dimensions are largely determined by dietary salt in patients with primary aldosteronism: results of a case-control study. J Clin Endocrinol Metab 2011; 96: 2813-2820
    CrossrefPubMedSearch in Google Scholar
  • 36 Rossi GP, Cesari M, Letizia C, Seccia TM, Cicala MV, Zinnamosca L, Kuppusamy M, Mareso S, Sciomer S, Iacobone M, Mantero F, Pessina AC. KCNJ5 gene somatic mutations affect cardiac remodelling but do not preclude cure of high blood pressure and regression of left ventricular hypertrophy in primary aldosteronism. J Hypertens 2014; 32: 1514-1521 discussion 1522
    CrossrefPubMedSearch in Google Scholar
  • 37 Rossi GP, Cesari M, Cuspidi C, Maiolino G, Cicala MV, Bisogni V, Mantero F, Pessina AC. Long-term control of arterial hypertension and regression of left ventricular hypertrophy with treatment of primary aldosteronism. Hypertension 2013; 62: 62-69
    CrossrefPubMedSearch in Google Scholar
  • 38 Gaddam K, Corros C, Pimenta E, Ahmed M, Denney T, Aban I, Inusah S, Gupta H, Lloyd SG, Oparil S, Husain A, Dell’Italia LJ, Calhoun DA. Rapid reversal of left ventricular hypertrophy and intracardiac volume overload in patients with resistant hypertension and hyperaldosteronism: a prospective clinical study. Hypertension 2010; 55: 1137-1142
    CrossrefPubMedSearch in Google Scholar
  • 39 Marzano L, Colussi G, Sechi LA, Catena C. Adrenalectomy is comparable with medical treatment for reduction of left ventricular mass in primary aldosteronism: meta-analysis of long-term studies. Am J Hypertens 2015; 28: 312-318
    CrossrefPubMedSearch in Google Scholar
  • 40 Lin YH, Lee HH, Liu KL, Lee JK, Shih SR, Chueh SC, Lin WC, Lin LC, Lin LY, Chung SD, Wu VC, Kuo CC, Ho YL, Chen MF, Wu KD. Reversal of myocardial fibrosis in patients with unilateral hyperaldosteronism receiving adrenalectomy. Surgery 2011; 150: 526-533
    CrossrefPubMedSearch in Google Scholar
  • 41 Lin YH, Wu XM, Lee HH, Lee JK, Liu YC, Chang HW, Lin CY, Wu VC, Chueh SC, Lin LC, Lo MT, Ho YL, Wu KD. Adrenalectomy reverses myocardial fibrosis in patients with primary aldosteronism. J Hypertens 2012; 30: 1606-1613
    CrossrefPubMedSearch in Google Scholar
  • 42 Catena C, Colussi G, Lapenna R, Nadalini E, Chiuch A, Gianfagna P, Sechi LA. Long-term cardiac effects of adrenalectomy or mineralocorticoid antagonists in patients with primary aldosteronism. Hypertension 2007; 50: 911-918
    CrossrefPubMedSearch in Google Scholar
  • 43 Widimsky Jr J, Strauch B, Petrak O, Rosa J, Somloova Z, Zelinka T, Holaj R. Vascular disturbances in primary aldosteronism: clinical evidence. Kidney Blood Press Res 2012; 35: 529-533
    CrossrefPubMedSearch in Google Scholar
  • 44 Taddei S, Virdis A, Mattei P, Salvetti A. Vasodilation to acetylcholine in primary and secondary forms of human hypertension. Hypertension 1993; 21: 929-933
    CrossrefPubMedSearch in Google Scholar
  • 45 Matsumoto T, Oki K, Kajikawa M, Nakashima A, Maruhashi T, Iwamoto Y, Iwamoto A, Oda N, Hidaka T, Kihara Y, Kohno N, Chayama K, Goto C, Aibara Y, Noma K, Liao JK, Higashi Y. Effect of aldosterone-producing adenoma on endothelial function and Rho-associated kinase activity in patients with primary aldosteronism. Hypertension 2015; 65: 841-848
    Search in Google Scholar
  • 46 Wu VC, Lo SC, Chen YL, Huang PH, Tsai CT, Liang CJ, Kuo CC, Kuo YS, Lee BC, Wu EL, Lin YH, Sun YY, Lin SL, Chen JW, Lin SJ, Wu KD. Endothelial progenitor cells in primary aldosteronism: a biomarker of severity for aldosterone vasculopathy and prognosis. J Clin Endocrinol Metab 2011; 96: 3175-3183
    CrossrefPubMedSearch in Google Scholar
  • 47 Rizzoni D, Paiardi S, Rodella L, Porteri E, De Ciuceis C, Rezzani R, Boari GE, Zani F, Miclini M, Tiberio GA, Giulini SM, Rosei CA, Bianchi R, Rosei EA. Changes in extracellular matrix in subcutaneous small resistance arteries of patients with primary aldosteronism. J Clin Endocrinol Metab 2006; 91: 2638-2642
    CrossrefPubMedSearch in Google Scholar
  • 48 Muiesan ML, Rizzoni D, Salvetti M, Porteri E, Monteduro C, Guelfi D, Castellano M, Garavelli G, Agabiti-Rosei E. Structural changes in small resistance arteries and left ventricular geometry in patients with primary and secondary hypertension. J Hypertens 2002; 20: 1439-1444
    CrossrefPubMedSearch in Google Scholar
  • 49 Gosk-Przybylek M, Harazny J, Binczyk E, Szymanek K, Prejbisz A, Szaflik J, Kolodziejczyk-Kruk S, Pregowska-Chwala B, Makowiecka-Ciesla M, Janas J, Kadziela J, Warchol-Celinska E, Ambroziak U, Bednarczuk T, Toutounchi S, Narkiewicz K, Reincke M, Schmieder RE, Januszewicz A. 7d.11: Retinal Arteriolar Structure in Patients with Primary Aldosteronism. J Hypertens 2015; 33 (Suppl. 01) e103
    CrossrefPubMedSearch in Google Scholar
  • 50 Holaj R, Zelinka T, Wichterle D, Petrak O, Strauch B, Widimsky Jr J. Increased intima-media thickness of the common carotid artery in primary aldosteronism in comparison with essential hypertension. J Hypertens 2007; 25: 1451-1457
    CrossrefPubMedSearch in Google Scholar
  • 51 Holaj R, Rosa J, Zelinka T, Strauch B, Petrak O, Indra T, Somloova Z, Michalsky D, Novak K, Wichterle D, Widimsky Jr J. Long-term effect of specific treatment of primary aldosteronism on carotid intima-media thickness. J Hypertens 2015; 33: 874-882
    CrossrefPubMedSearch in Google Scholar
  • 52 Lin YH, Lin LY, Chen A, Wu XM, Lee JK, Su TC, Wu VC, Chueh SC, Lin WC, Lo MT, Wang PC, Ho YL, Wu KD. Adrenalectomy improves increased carotid intima-media thickness and arterial stiffness in patients with aldosterone producing adenoma. Atherosclerosis 2012; 221: 154-159
    CrossrefPubMedSearch in Google Scholar
  • 53 Rosa J, Somloova Z, Petrak O, Strauch B, Indra T, Senitko M, Zelinka T, Holaj R, Widimsky Jr J. Peripheral arterial stiffness in primary aldosteronism. Physiol Res 2012; 61: 461-468
    CrossrefPubMedSearch in Google Scholar
  • 54 Strauch B, Petrak O, Wichterle D, Zelinka T, Holaj R, Widimsky Jr J. Increased arterial wall stiffness in primary aldosteronism in comparison with essential hypertension. Am J Hypertens 2006; 19: 909-914
    CrossrefPubMedSearch in Google Scholar
  • 55 Catena C, Colussi G, Sechi LA. Mineralocorticoid receptor antagonists and renal involvement in primary aldosteronism: opening of a new era. Eur J Endocrinol 2013; 168: C1-C5
    CrossrefPubMedSearch in Google Scholar
  • 56 Helal I, Fick-Brosnahan GM, Reed-Gitomer B, Schrier RW. Glomerular hyperfiltration: definitions, mechanisms and clinical implications. Nat Rev Nephrol 2012; 8: 293-300
    CrossrefPubMedSearch in Google Scholar
  • 57 Rossi GP, Bernini G, Desideri G, Fabris B, Ferri C, Giacchetti G, Letizia C, Maccario M, Mannelli M, Matterello MJ, Montemurro D, Palumbo G, Rizzoni D, Rossi E, Pessina AC, Mantero F. Renal damage in primary aldosteronism: results of the PAPY Study. Hypertension 2006; 48: 232-238
    CrossrefPubMedSearch in Google Scholar
  • 58 Ribstein J, Du Cailar G, Fesler P, Mimran A. Relative glomerular hyperfiltration in primary aldosteronism. J Am Soc Nephrol 2005; 16: 1320-1325
    CrossrefPubMedSearch in Google Scholar
  • 59 Sechi LA, Novello M, Lapenna R, Baroselli S, Nadalini E, Colussi GL, Catena C. Long-term renal outcomes in patients with primary aldosteronism. JAMA 2006; 295: 2638-2645
    CrossrefPubMedSearch in Google Scholar
  • 60 Reincke M, Rump LC, Quinkler M, Hahner S, Diederich S, Lorenz R, Seufert J, Schirpenbach C, Beuschlein F, Bidlingmaier M, Meisinger C, Holle R, Endres S. Risk factors associated with a low glomerular filtration rate in primary aldosteronism. J Clin Endocrinol Metab 2009; 94: 869-875
    CrossrefPubMedSearch in Google Scholar
  • 61 Kuo CC, Wu VC, Tsai CW, Wu KD. Relative kidney hyperfiltration in primary aldosteronism: a meta-analysis. J Renin Angiotensin Aldosterone Syst 2011; 12: 113-122
    CrossrefPubMedSearch in Google Scholar
  • 62 Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol 2005; 45: 1243-1248
    CrossrefPubMedSearch in Google Scholar
  • 63 Savard S, Amar L, Plouin PF, Steichen O. Cardiovascular complications associated with primary aldosteronism: a controlled cross-sectional study. Hypertension 2013; 62: 331-336
    CrossrefPubMedSearch in Google Scholar
  • 64 Catena C, Colussi G, Nadalini E, Chiuch A, Baroselli S, Lapenna R, Sechi LA. Cardiovascular outcomes in patients with primary aldosteronism after treatment. Arch Intern Med 2008; 168: 80-85
    CrossrefPubMedSearch in Google Scholar
  • 65 Mulatero P, Monticone S, Bertello C, Viola A, Tizzani D, Iannaccone A, Crudo V, Burrello J, Milan A, Rabbia F, Veglio F. Long-term cardio- and cerebrovascular events in patients with primary aldosteronism. J Clin Endocrinol Metab 2013; 98: 4826-4833
    CrossrefPubMedSearch in Google Scholar
  • 66 Turchi F, Ronconi V, di Tizio V, Ceccoli L, Boscaro M, Giacchetti G. Primary aldosteronism and essential hypertension: assessment of cardiovascular risk at diagnosis and after treatment. Nutr Metab Cardiovasc Dis 2014; 24: 476-482
    CrossrefPubMedSearch in Google Scholar
  • 67 Born-Frontsberg E, Reincke M, Rump LC, Hahner S, Diederich S, Lorenz R, Allolio B, Seufert J, Schirpenbach C, Beuschlein F, Bidlingmaier M, Endres S, Quinkler M. Cardiovascular and cerebrovascular comorbidities of hypokalemic and normokalemic primary aldosteronism: results of the German Conn’s Registry. J Clin Endocrinol Metab 2009; 94: 1125-1130
    CrossrefPubMedSearch in Google Scholar
  • 68 Reincke M, Fischer E, Gerum S, Merkle K, Schulz S, Pallauf A, Quinkler M, Hanslik G, Lang K, Hahner S, Allolio B, Meisinger C, Holle R, Beuschlein F, Bidlingmaier M, Endres S. Observational study mortality in treated primary aldosteronism: the German Conn’s registry. Hypertension 2012; 60: 618-624
    CrossrefPubMedSearch in Google Scholar