Ricerc@Sapienza

Primary aldosteronism (PA), the most frequent form of secondary arterial hypertension, is strictly associated to several cardiovascular complications and target organ damage, due to pro-inflammatory and oxidative effects, vascular and renal fibrosis and unfavorable metabolic effects of aldosterone.
Recently, we have shown that another adrenal hormone, cortisol, beyond systemic manifestations (hypertension, abnormalities in glucose and lipid metabolism), is associated with dilated cardiomyopathy, due to histological changes and molecular pathways, as well as cardiomyocyte hypertrophy, myofibrillolysis and myocardial fibrosis; changes reverted completely at 1-year follow-up from removal of cortisol excess (adrenalectomy).
In literature many studies have evaluated the potential pathophysiological links between myocardial remodeling and aldosterone behaviors, especially on animal models, nevertheless none pathophysiological process can be precisely identified in human model.
To this purpose, a prospective randomized study will be drawn up, involving homogeneous groups of patients in distinct groups: PA patients undergoing surgical (adrenalectomy) or conservative approach (pharmacological) matched patients with essential hypertension.
All patients will undergo to biochemical, hormonal and antropometric evaluation, echocardiographic and magnetic resonance evaluation of heart, endomyocardial biopsy in selected patients presenting with left ventricular dilation and dysfunction, distinct in accordance with the presence of PA and EH. Endomyocardial biopsy samples will be processed for histology, electronmicroscopy and immunohistochemistry and western blot.
The aims of the study are the more precise identification and type of myocardial alterations in patients affected by overt PA and cardiomyopathy compared with patients with equivalent severity of cardiomyopathy and EH, in order to understand the patho-physiological role of aldosterone in mediating cardiovascular damage.