Endothelial function in primary hyperaldosteronism vs essential arterial hypertension

Objective. To estimate and compare the endothelial function in patients with essential arterial hypertension (HTN) and primary hyperaldosteronism (PHA). Design and methods. Eighty-two patients were examined. Among them, PHA was verified in 19 patients, while 36 patients had essential HTN stage II (blood pressure (BP) elevation of 1st or 2nd degree), and 27 age-matching healthy people formed control group. The HTN duration in PHA patients was 1,95 ± 0,24 years, and in patients with essential HTN — 5,5 ± 0,5 years. Both patients and healthy peoples were examined within the hospital, in compliance with the hospital regime and diet. Endothelial function was assessed by several methods: the number of circulating desquamated endothelial cells (the method by Hladovec J.), reactive hyperemia test and evaluation of endothelium-dependent vasodilation (as a percentage of the brachial artery diameter increase), total blood nitrates and nitrites level (Griss-reaction method), nitric oxide excretion in urine. Results. Endothelial dysfunction (ED) was found in all patients with high BP. We found more profound ED in PHA patients compared to patients with essential HTN, which resulted in a significantly higher number of circulating endothelial desquamated cells, lower percentage of vasodilation response in reactive hyperemia test, decreased blood levels of total nitrites/nitrates and elevated nitric oxide urine excretion. Discriminant analysis was applied to range the severity of ED. Patients with essential HTN had moderate ED, while patients with PHA had severe ED. Conclusions. The proposed classification approach can be successfully applied for monitoring changesin ED and the effectiveness of treatment in patients with various diseases associated with BP elevation. 

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