Document Detail


Reversible sympathetic overactivity in hypertensive patients with primary aldosteronism.
MedLine Citation:
PMID:  20660053     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Aldosterone has been shown to exert a central sympathoexcitatory action in multiple animal models, but evidence in humans is still lacking.
OBJECTIVES: Our objective was to determine whether hyperaldosteronism causes reversible sympathetic activation in humans.
METHODS: We performed a cross-sectional comparison of muscle sympathetic nerve activity (SNA, intraneural microelectrodes) in 14 hypertensive patients with biochemically proven primary aldosteronism (PA) with 20 patients with essential hypertension (EH) and 18 age-matched normotensive (NT) controls. Seven patients with aldosterone-producing adenoma (APA) were restudied 1 month after unilateral adrenalectomy.
RESULTS: Mean blood pressure values in patients with PA and EH and NT controls was 145 ± 4/88 ± 2, 150 ± 4/90 ± 2, and 119 ± 2/76 ± 2 mm Hg, respectively. The major new findings are 2-fold: 1) baseline SNA was significantly higher in the PA than the NT group (40 ± 3 vs. 30 ± 2 bursts/min, P = 0.014) but similar to the EH group (41 ± 3 bursts/min) and 2) after unilateral adrenalectomy for APA, SNA decreased significantly from 38 ± 5 to 27 ± 4 bursts/min (P = 0.01), plasma aldosterone levels fell from 72.4 ± 20.3 to 11.4 ± 2.3 ng/dl (P < 0.01), and blood pressure decreased from 155 ± 8/94 ± 3 to 117 ± 4/77 ± 2 mm Hg (P < 0.01).
CONCLUSION: These data provide the first evidence in humans that APA is accompanied by reversible sympathetic overactivity, which may contribute to the accelerated hypertensive target organ disease in this condition.
Authors:
Andrew C Kontak; Zhongyun Wang; Debbie Arbique; Beverley Adams-Huet; Richard J Auchus; Shawna D Nesbitt; Ronald G Victor; Wanpen Vongpatanasin
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-07-21
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  95     ISSN:  1945-7197     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-07     Completed Date:  2010-11-15     Revised Date:  2013-03-28    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  4756-61     Citation Subset:  AIM; IM    
Affiliation:
Cardiology Division, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8586, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00353652
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MeSH Terms
Descriptor/Qualifier:
Adrenalectomy
Adult
Blood Pressure / physiology
Case-Control Studies
Cross-Sectional Studies
Female
Humans
Hyperaldosteronism / physiopathology*
Hypertension / physiopathology*
Male
Middle Aged
Sympathetic Nervous System / physiology,  physiopathology*
Grant Support
ID/Acronym/Agency:
HL-078782/HL/NHLBI NIH HHS; R01HL-078782/HL/NHLBI NIH HHS; UL1RR-024982/RR/NCRR NIH HHS
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