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Left ventricular remodeling and dysfunction in primary aldosteronism

Journal of Human Hypertension volume 35, pages 131–147 (2021)Cite this article

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Abstract

Primary aldosteronism (PA) is a common cause of secondary hypertension and is associated with worse cardiovascular outcomes. The elevated aldosterone in PA leads to left ventricular (LV) remodeling and dysfunction. In recent decades, clinical studies have demonstrated worse LV remodeling including increased LV mass and cardiac fibrosis in patients with PA compared to patients with essential hypertension. Several mechanisms may explain the process of aldosterone-induced LV remodeling, including directly profibrotic and hypertrophic effects of aldosterone on myocardium, increased reactive oxygen species and profibrotic molecules, dysregulation of extracellular matrix metabolism, endothelium dysfunction and circulatory macrophages activation. LV remodeling causes LV diastolic and systolic dysfunction, which may consequently lead to clinical complications such as heart failure, atrial fibrillation, ischemic heart disease, and other vascular events. Adequate treatment with adrenalectomy or medical therapy can improve LV remodeling and dysfunction in PA patients. In this review, we discuss the mechanisms of aldosterone-induced LV remodeling and provide an up-to-date review of clinical research about LV remodeling-related heart structural changes, cardiac dysfunction, and their clinical impacts on patients with PA.

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Fig. 1: There are three major mechanisms of alsosterone induced LV remodeling including myocytes hyperthropathy, chronic inflammation and ECM dysregulation.

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Acknowledgements

This research was supported by grants from the Ministry of Science and Technology (MOST 105-2314-B-002-122-MY3, MOST 106-2314-B-002-169-MY3 and MOST 107-2314-B-002 -264 -MY3), National Taiwan University Hospital (NTUH 107-A141, 108-A141, 109-A141, 108-N01, 108-S4382, UN108-37), and the Excellent Translational Medicine Research Projects of National Taiwan University College of Medicine, and National Taiwan University Hospital (109C 101-43).

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  1. Department of Internal Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan

    Cheng-Hsuan Tsai

  2. Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Cheng-Hsuan Tsai, Chien-Ting Pan, Zheng-Wei Chen, Chi-Sheng Hung & Yen-Hung Lin

  3. Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan

    Chien-Ting Pan & Zheng-Wei Chen

  4. Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan

    Yi-Yao Chang

  5. Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Vin-Cent Wu

  6. Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan

    Chi-Sheng Hung & Yen-Hung Lin

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Tsai, CH., Pan, CT., Chang, YY. et al. Left ventricular remodeling and dysfunction in primary aldosteronism. J Hum Hypertens 35, 131–147 (2021). https://doi.org/10.1038/s41371-020-00426-y

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