LAUSR

OBJECTIVE The presence of autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA) is common and potentially associated with poor outcomes. The aim of this study was to investigate the association between autonomous cortisol secretion and vascular remodeling in PA patients. DESIGN AND METHODS We prospectively enrolled 436 PA patients from October 2006 to November 2019. ACS (defined as a cortisol level >1.8 μg/dL after a 1 mg dexamethasone suppression test) was detected in 23% of the PA patients. Propensity score matching with age, sex, systolic and diastolic blood pressure was performed. The brachial-ankle pulse wave velocity (baPWV) was examined at baseline and one year after targeted treatment. Small arteries of periadrenal fat in 46 patients were stained with Picro Sirus red to quantify the severity of vascular fibrosis. RESULTS After propensity score matching, the PA patients with ACS had a significantly higher prevalence of diabetes mellitus, higher plasma aldosterone concentration and higher aldosterone to renin ratio. The baseline mean baPWV was also significantly higher in the PA patients with ACS. After multivariable regression analysis, the presence of ACS was a significant predictor of worse baseline mean baPWV (β: 235.745, 95% CI: 59.602~411.888, P=0.010). In addition, the PA patients with ACS had worse vascular fibrosis (fibrosis area: 25.6±8.4%) compared to those without ACS (fibrosis area: 19.8±7.7%, P=0.020). After one year of PA treatment, baPWV significantly improved in both groups. CONCLUSION The presence of ACS in PA patients is associated with worse arterial stiffness and vascular remodeling.