Hypertension. 2026 Mar 25. doi: 10.1161/HYPERTENSIONAHA.125.26213. Online ahead of print.
ABSTRACT
BACKGROUND: Sex differences influence cardiovascular risk assessment and management; however, their role in aldosterone-mediated cardiac remodeling in primary aldosteronism remains incompletely understood.
METHODS: We conducted a retrospective study of 547 patients with primary aldosteronism, including 249 men and 298 women. Clinical and echocardiographic data were collected at baseline and 1 year following aldosterone-targeted therapies.
RESULTS: The mean age was 53.8 years in men and 54.6 years in women. At baseline, men had a higher left ventricular mass index (LVMI), whereas women had a higher prevalence of left ventricular (LV) hypertrophy and worse diastolic function, as indicated by a higher ratio of early diastolic transmitral to mitral annular velocity (E/e’) and left atrial volume index. In multivariable analyses, plasma aldosterone concentration was associated with baseline LVMI in both sexes. Associations between plasma aldosterone concentration and baseline diastolic indices, including E/e’ and left atrial volume index, were observed in men but not in women in sex-stratified models. However, formal interaction testing did not demonstrate significant sex-by- plasma aldosterone concentration interactions for left atrial volume index, E/e’, or LAVI. After 1 year of treatment, LVMI reduction was comparable between sexes. Improvement in E/e’ was significantly less pronounced in women. LAVI decreased significantly in men but not in women, although between-sex differences in change were not statistically significant.
CONCLUSIONS: Sex-specific differences in cardiac remodeling and diastolic function were observed in patients with primary aldosteronism. Despite lower baseline LVMI, women exhibited a more adverse cardiac phenotype, with a higher prevalence of left ventricular hypertrophy and worse diastolic function. Following aldosterone-targeted therapies, structural regression was similar between sexes, whereas diastolic function improved to a lesser extent in women.
PMID:41878808 | DOI:10.1161/HYPERTENSIONAHA.125.26213
