Subclinical target organ damage in primary aldosteronism: resistant to spironolactone therapy?

Subclinical target organ damage in primary aldosteronism: resistant to spironolactone therapy? Correspondence previously treated with spironolactone [5,6] and could Subclinical target organ damage in reflect a confounding factor on ARR outcomes. Could primary aldosteronism: resistant to the authors clarify whether the same wash-out period (3 weeks) was applied for spironolactone users as well spironolactone therapy? or a larger wash-out period was applied in this group? Konstantinos Stavropoulos , a b Konstantinos P. Imprialos , Michael Doumas , ACKNOWLEDGEMENTS a a Vasilios G. Athyros , and Asterios Karagiannis Conflicts of interest There are no conflicts of interest. e read with great interest the study by Chen et al. REFERENCES [1]. The study confirmed the extended target- 1. Chen ZW, Huang KC, Lee JK, Lin LC, Chen CW, Chang YY, et al. Aldosterone induces left ventricular subclinical systolic dysfunction: a strain W organ damage in patients with primary aldoster- imaging study. JHypertens 2017; doi:10.1097/HJH.0000000000001534. onism by evaluating several echocardiographic indexes of [Epub ahead of print]. left ventricular function. However, we would like to make a 2. ESH/ESC Task Force for the Management of Arterial Hypertension. few points. 2013 Practice guidelines for the management of arterial hypertension of First, the selection criteria for the control group are not the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of clearly defined in the Materials and Methods section. How Arterial Hypertension. J Hypertens 2013; 31:1925–1938. were the 31 study participants with essential hypertension 3. Tamargo J, Solini A, Ruilope LM. Comparison of agents that affect selected? Relevant clarification is essential to exclude aldosterone action. Semin Nephrol 2014; 34:285–306. selection bias and subsequent concerns on the validity of 4. Grandi AM, Imperiale D, Santillo R, Barlocco E, Bertolini A, Guasti L, et al. Aldosterone antagonist improves diastolic function in essential study findings. hypertension. Hypertension 2002; 40:647–652. Second, antihypertensive agents such as renin–angio- 5. Stavropoulos K, Imprialos KP, Doumas M. Bypass of confirmatory tests tensin blockers, beta blockers, and mineralocorticoid for case detection of primary aldosteronism in leaner patients? J Clin antagonists exert beneficial effects on myocardium [2]. Hypertens (Greenwich) 2017; 19:798–800. 6. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Despite, the insignificant disparities of the study subgroups et al. The management of primary aldosteronism: case detection, in the use of renin–angiotensin blockers, spironolactone diagnosis, and treatment: an Endocrine Society clinical practice guide- and beta blockers were more frequently administered in the line. J Clin Endocrinol Metab 2016; 101:1889–1916. primary aldosteronism arm. Especially, the between-group difference in spironolactone use might mask the magnitude of primary aldosteronism detrimental effect on left ventric- Journal of Hypertension 2018, 36:701–704 ular systolic function. In brief, accumulating data suggests Second Propedeutic Department of Internal Medicine, Hippokration Hospital, Aris- that mineralocorticoid antagonist administration could lead totle University of Thessaloniki, Thessaloniki, Macedonia, Greece and VAMC and George Washington University, Washington DC, USA to amelioration in left ventricular mass index and diastolic Correspondence to Konstantinos P. Imprialos, MD, Second Propedeutic Department dysfunction in patients with arterial hypertension, and long- of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, term cardiovascular benefits of these agents are thought to Macedonia, Greece. Tel: +30 6981113262; e-mail: kostasimprialos@hotmail.com be attributed to improvements in left ventricular function J Hypertens 36:701–704 Copyright  2018 Wolters Kluwer Health, Inc. All rights reserved. and remodeling [3,4]. Given that all of the patients on DOI:10.1097/HJH.0000000000001642 spironolactone (n¼ 13) were included in the primary aldosteronism subgroup (Table 1) in [1], it would be enlightening if the authors could conduct a sub-analysis of the outcomes after the exclusion of patients that were previously treated with spironolactone. Even if this analysis restricts the sample size, it could unveil a more accurate Reply association between primary aldosteronism and left ven- tricular systolic dysfunction. Zheng-Wei Chen, Vin-Cent Wu, Finally, it is well established that almost all antihyper- Yen-Hung Lin, the TAIPAI study group tensive drugs significantly affect the aldosterone-to-renin ratio (ARR) [5]. Specifically, spironolactone stimulates renin secretion, thus decreasing the ARR. In the study, partici- e would like to thank Stavropoulos et al. [1] their pants underwent a 3-week wash-out period by using agents with a minimal effect on ARR, as stated in the Materials and comments regarding our article entitled Methods section [1]. This wash-out period is shorter than W ‘Aldosterone induces left ventricular subclinical the 4 weeks (by some experts, 6 weeks) that is recom- systolic dysfunction – a strain imaging study’ [2]. In that mended for the appropriate evaluation of ARR in patients study, we showed the influence of aldosterone on left Journal of Hypertension www.jhypertension.com 701 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Hypertension Wolters Kluwer Health

Subclinical target organ damage in primary aldosteronism: resistant to spironolactone therapy?

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Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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Abstract

Correspondence previously treated with spironolactone [5,6] and could Subclinical target organ damage in reflect a confounding factor on ARR outcomes. Could primary aldosteronism: resistant to the authors clarify whether the same wash-out period (3 weeks) was applied for spironolactone users as well spironolactone therapy? or a larger wash-out period was applied in this group? Konstantinos Stavropoulos , a b Konstantinos P. Imprialos , Michael Doumas , ACKNOWLEDGEMENTS a a Vasilios G. Athyros , and Asterios Karagiannis Conflicts of interest There are no conflicts of interest. e read with great interest the study by Chen et al. REFERENCES [1]. The study confirmed the extended target- 1. Chen ZW, Huang KC, Lee JK, Lin LC, Chen CW, Chang YY, et al. Aldosterone induces left ventricular subclinical systolic dysfunction: a strain W organ damage in patients with primary aldoster- imaging study. JHypertens 2017; doi:10.1097/HJH.0000000000001534. onism by evaluating several echocardiographic indexes of [Epub ahead of print]. left ventricular function. However, we would like to make a 2. ESH/ESC Task Force for the Management of Arterial Hypertension. few points. 2013 Practice guidelines for the management of arterial hypertension of First, the selection criteria for the control group are not the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of clearly defined in the Materials and Methods section. How Arterial Hypertension. J Hypertens 2013; 31:1925–1938. were the 31 study participants with essential hypertension 3. Tamargo J, Solini A, Ruilope LM. Comparison of agents that affect selected? Relevant clarification is essential to exclude aldosterone action. Semin Nephrol 2014; 34:285–306. selection bias and subsequent concerns on the validity of 4. Grandi AM, Imperiale D, Santillo R, Barlocco E, Bertolini A, Guasti L, et al. Aldosterone antagonist improves diastolic function in essential study findings. hypertension. Hypertension 2002; 40:647–652. Second, antihypertensive agents such as renin–angio- 5. Stavropoulos K, Imprialos KP, Doumas M. Bypass of confirmatory tests tensin blockers, beta blockers, and mineralocorticoid for case detection of primary aldosteronism in leaner patients? J Clin antagonists exert beneficial effects on myocardium [2]. Hypertens (Greenwich) 2017; 19:798–800. 6. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Despite, the insignificant disparities of the study subgroups et al. The management of primary aldosteronism: case detection, in the use of renin–angiotensin blockers, spironolactone diagnosis, and treatment: an Endocrine Society clinical practice guide- and beta blockers were more frequently administered in the line. J Clin Endocrinol Metab 2016; 101:1889–1916. primary aldosteronism arm. Especially, the between-group difference in spironolactone use might mask the magnitude of primary aldosteronism detrimental effect on left ventric- Journal of Hypertension 2018, 36:701–704 ular systolic function. In brief, accumulating data suggests Second Propedeutic Department of Internal Medicine, Hippokration Hospital, Aris- that mineralocorticoid antagonist administration could lead totle University of Thessaloniki, Thessaloniki, Macedonia, Greece and VAMC and George Washington University, Washington DC, USA to amelioration in left ventricular mass index and diastolic Correspondence to Konstantinos P. Imprialos, MD, Second Propedeutic Department dysfunction in patients with arterial hypertension, and long- of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, term cardiovascular benefits of these agents are thought to Macedonia, Greece. Tel: +30 6981113262; e-mail: kostasimprialos@hotmail.com be attributed to improvements in left ventricular function J Hypertens 36:701–704 Copyright  2018 Wolters Kluwer Health, Inc. All rights reserved. and remodeling [3,4]. Given that all of the patients on DOI:10.1097/HJH.0000000000001642 spironolactone (n¼ 13) were included in the primary aldosteronism subgroup (Table 1) in [1], it would be enlightening if the authors could conduct a sub-analysis of the outcomes after the exclusion of patients that were previously treated with spironolactone. Even if this analysis restricts the sample size, it could unveil a more accurate Reply association between primary aldosteronism and left ven- tricular systolic dysfunction. Zheng-Wei Chen, Vin-Cent Wu, Finally, it is well established that almost all antihyper- Yen-Hung Lin, the TAIPAI study group tensive drugs significantly affect the aldosterone-to-renin ratio (ARR) [5]. Specifically, spironolactone stimulates renin secretion, thus decreasing the ARR. In the study, partici- e would like to thank Stavropoulos et al. [1] their pants underwent a 3-week wash-out period by using agents with a minimal effect on ARR, as stated in the Materials and comments regarding our article entitled Methods section [1]. This wash-out period is shorter than W ‘Aldosterone induces left ventricular subclinical the 4 weeks (by some experts, 6 weeks) that is recom- systolic dysfunction – a strain imaging study’ [2]. In that mended for the appropriate evaluation of ARR in patients study, we showed the influence of aldosterone on left Journal of Hypertension www.jhypertension.com 701 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

Journal

Journal of HypertensionWolters Kluwer Health

Published: Mar 1, 2018

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