Increased prevalence of abdominal aortic aneurysm in biochemically confirmed primary aldosteronism: a new complication?

BACKGROUND

Aldosterone excess in primary aldosteronism (PA) has been implicated in vascular remodeling and aortic pathology. However, the prevalence of abdominal aortic aneurysm (AAA) in PA patients remains largely unexplored. This study aimed to evaluate AAA prevalence among patients with biochemically confirmed PA and to explore potential aldosterone-mediated vascular effects.

METHODS

In this single-center, case-control study, 73 PA patients and 74 age- and sex-matched individuals with essential hypertension were included. Patients with smoking history, connective tissue disorders, vasculitis, or other secondary hypertension causes were excluded. Laboratory assessments included plasma aldosterone concentration, plasma renin activity, and routine metabolic panels. AAA and other vascular abnormalities were retrospectively assessed via abdominal computed tomography and echocardiography.

RESULTS

Among 73 patients with PA, AA) was identified in 5 individuals and in none of the 74 matched hypertensive controls (p=0.028). All AAA cases were infrarenal, with a median diameter of 43.4 mm, predominantly male, and had long-standing requiring multiple antihypertensive agents. Ascending aortic dilatation was observed in 11 PA patients compared with 5 controls (p=0.106), while intracranial aneurysms were detected in 2 PA patients and none of the controls. Echocardiography revealed left ventricular hypertrophy in 39.7% of PA patients versus 27.0% of controls, with comparable left atrial dimensions and ejection fraction between groups. Regarding PA subtypes, 49.4% had aldosterone-producing adenoma and 50.6% had bilateral adrenal hyperplasia.

CONCLUSION

This study is the first to systematically demonstrate an increased prevalence of AAA among PA patients compared with hypertensive controls. Findings suggest that aldosterone excess may contribute to systemic arteriopathy affecting multiple vascular territories. These results underscore the potential value of targeted vascular imaging in selected PA patients, particularly those with prolonged hypertension or high aldosterone levels, for early detection and risk stratification.