Association of Plasma Aldosterone Concentration After Captopril Suppression Test With Left Ventricular Remodeling and Diastolic Dysfunction in Primary Aldosteronism

Objective: Cardiac remodeling is a critical pathological manifestation in primary aldosteronism (PA) attributed to excessive aldosterone secretion. The plasma aldosterone concentration (PAC) following the captopril suppression test (CCT) may serve as an indicator of unregulated aldosterone and could potentially offer improved predictive value for cardiovascular outcomes. This study aimed to explore the association between nadir aldosterone levels post-CCT and left ventricular remodeling as well as diastolic dysfunction. Design and method: We conducted a retrospective analysis of PA patients within the TAIPAI (Taiwan Primary Aldosteronism Investigation) cohort with complete baseline and post-CCT plasma renin activity (PRA), PAC, aldosterone-to-renin ratio (ARR), and echocardiography data for further investigation. Results: A total of 540 patients were included in the study. Among baseline and post-CCT PRA, PAC, and ARR, post-CCT PAC exhibited the strongest correlation with left ventricular mass index (LVMI) and diastolic dysfunction (E/e’). In multivariable regression analysis, post-CCT PAC emerged as an independent predictor of LVMI (beta: 24.6, 95% CI: 9.6 to 39.5, P=0.001) and diastolic dysfunction (beta: 1.9, 95% CI: 0.5 to 3.3, P=0.006). Restricted cubic spline analysis revealed significant correlations between both baseline and post-CCT PAC with LVMI, whereas only post-CCT PAC exhibited a significant correlation with diastolic function. Conclusions: Plasma aldosterone concentration following CCT, reflective of unregulated aldosterone excess, is significantly associated with left ventricular hypertrophy and diastolic dysfunction. PA patients with elevated post-CCT PAC may face increased cardiovascular risks, underscoring the importance of timely and appropriate management.