Left Ventricular Mass and Geometry Before and After Etiologic Treatment in Renovascular Hypertension, Aldosterone-Producing Adenoma, and Pheochromocytoma

To study left ventricular (LV) geometry in secondary hypertension and its evolution following etiologic treatment, echocardiography was performed in a total of 73 patients: 40 patients with renovascular hypertension (RVH), 21 with aldosterone-producing adenoma (APA), and 12 with pheochromocytoma (PH). Repeat echocardiography was possible in 43 of these patients, 3-24 months following curative renal revascularization or adrenal surgery. Age, sex ratio, and initial drug treatment score were comparable in the three etiologic categories, but 24-h ambulatory blood pressure and LV mass index were significantly higher in APA and RVH than in PH. End-diastolic LV volume was significantly smaller in PH than in APA and RVH. After treatment, the greatest reduction in LV mass occurred in APA (-18%, P < .05) and the lowest in PH (-5%, NS). Both patients with APA and those with PH exhibited a significant decrease in LV wall thickness, whereas LV diameter tended to decrease in APA patients and to increase in PH patients. No significant cardiac changes occurred in RVH patients after treatment. Although LV mass index and ambulatory blood pressure were correlated both before and after treatment, LV mass index changes did not correlate with changes in ambulatory blood pressure or with the known duration of hypertension. Systolic function was normal before and following etiologic treatment in the three categories. These findings suggest that, in addition to blood pressure, volume and/or humoral factors influence the pathogenesis of left ventricular hypertrophy and its reversibility.