NTpro-BNP levels in patients with primary hyperaldosteronism and autonomous cortisol co-secretion

Context Patients with primary aldosteronism (PA) have higher cardiac comorbidities including more pronounced left ventricular hypertrophy than patients with essential hypertension. Objective Autonomous cortisol co-secretion (ACS) is a common subtype in PA associated with a worse metabolic profile. Hypothesis ACS may affect myocardial parameters and result in a worse cardiac outcome compared to patients with PA and without ACS. Methods 367 patients with PA undergoing 1mg dexamethasone suppression test (DST) and echocardiography at baseline from two centers of the German Conn´s Registry were included. Follow-up for up to 3.8yrs was available in 192 patients. Results Patients with PA and ACS had higher NTpro-BNP levels at baseline compared to patients with PA without ACS (114vs75.6pg/ml,p=0.02), but showed no difference in echocardiography values. NTpro-BNP levels showed a significant positive correlation (r=0.141,p=0.011) with cortisol levels after DST at baseline. In response to therapy of PA, NTpro-BNP levels decreased, but remained significantly higher in patients with ACS compared to patients without ACS. At follow-up, left ventricle end diastolic dimension (LVEDD) decreased significantly only in patients without ACS. Left atrial diameter (LAD) decreased significantly in patients without ACS and in female patients with ACS but not in male patients. Left ventricular mass index (LVMI) significantly improved in female patients without ACS but remained unchanged in female patients with ACS as well as in male patients at follow-up. Conclusion In patients with PA, concomitant ACS is associated with a worse cardiac profile and only partial recovery even years after initiation of targeted PA therapy.