COMPARISON OF CHANGES IN CARDIAC STRUCTURE AFTER TREATMENT IN SECONDARY HYPERTENSION

To investigate the role of aldosterone and the renin-angiotensin syste m in cardiac structure, we performed echocardiography in patients with secondary hypertension. The relation between blood pressure or hormon al influences and left ventricular hypertrophy has not been well estab lished in secondary hypertension. Sixteen patients with primary aldost eronism and 11 with unilateral renovascular hypertension who had compl etely normalized blood pressure after operation or percutaneous transl uminal angioplasty were evaluated by echocardiography before and after surgery or other interventional treatment. Blood pressure was not sta tistically different between the groups before treatment and was norma lized after treatment in both groups. Left ventricular hypertrophy was mild in both groups before treatment, and its degree was not statisti cally different between the groups. At the end of the follow-up period , an parameters of primary aldosteronism and left ventricular mass ind ex in patients with unilateral renovascular hypertension were signific antly reduced. In patients with primary aldosteronism, changes in end- diastolic left ventricular internal dimension correlated positively wi th changes in left ventricular mass index (r=.58, P<.01). In patients with unilateral renovascular hypertension, changes in mean blood press ure and left ventricular mass index were significantly correlated (r=. 77, P<.01). The expanded plasma volume induced by an excess of aldoste rone and high blood pressure may play an important role in the increas e of left ventricular mass in primary aldosteronism. In unilateral ren ovascular hypertension, high blood pressure mainly contributes signifi cantly to increased left ventricular mass. Therefore, different factor s may modulate the development of left ventricular hypertrophy in pati ents with secondary hypertension.