Correlation Between 24 Hours Natriuresis And Target-organ Damage Of Heart In Patients With Primary Aldosterone And Patients With Primary Hypertension

Objective: To investigate the relationship between urinary sodium and target-organ damage of heart in patients with primary aldosterone and patients with primary hypertension.Method:A total of 199 patients with primary hypertension(PH)and 148 patients with primary aldosterone(PA)who were hospitalized in the First Affiliated Hospital of Dalian Medical University during 2018-2020 were selected continuously.The general clinical data,such as age,gender,course of hypertension,smoking history,body mass index(BMI),medication history were collected.Blood biochemical,urine sodium,urine potassium,Direct renin concentration(DRC),Plasma aldosterone concentration(PAC)and Angiotensin II(Ang II),ambulatory blood pressure monitor,echocardiogram were also collected.Baseline data,blood pressure and cardiac structure of the PH group and the PA group were compared,the PA and the PH group were divided into three subgroups according to “An expert recommendation on salt intake and blood pressure management in Chinese patients with hypertension”(normal salt intake less than 6 g/d,moderate salt intake 6-12 g/d and high salt intake greater than 12 g/d).Those with urinary sodium less than 100 mmol/24 h were classified as low urinary sodium group(PA-L and PH-L),100-200 mmol/24 h as medium urinary sodium group(PA-M and PH-M),and more than 200mmol/d as high urinary sodium group(PA-H and PH-H).To investigate whether the effects of urinary sodium on blood pressure and heart structure were consistent between the two group,the effects of urinary sodium on blood pressure and heart structure among subgroup of PH group and PA group were compared.Multiple linear regression analysis was used to calculate the relationship between urinary sodium,PAC and heart structure.Results:1.The PA group had higher blood pressure and severe heart damage than the PH group.2.In the primary hypertension group,blood pressures of 24 hours,daytime and nighttime(Systolic blood pressure,Diastolic pressure)in PH-L,PH-M and PH-H groups significantly increased with the increase of urinary sodium,and there were statistical differences among groups(all P<0.05).In the primary aldosterone group,the blood pressure of PA-L,PA-M and PA-H groups at 24 hours,daytime and night had no increasing trend,and there were no statistical significance between three subgroup(all P>0.05).3.In the PH group,Interventricular septal thickness(IST),Left ventricular posterior wall thickness(LVPWT),and left ventricular mass index(LVMI),Left ventricular and diastolic diameter(LVEDD)and Left atrial diameter(LAD)were all significant increased accompanied by the increased of urinary sodium among 3 subgroups(all P<0.05).In PA group,only LVEDD increased accompanied by the increased of urinary sodium(P=0.002).4.In PH group,24 hours natriuresis was significantly positively correlated with IST,LVPWT,LVMI,LVEDD and LAD(all P<0.05).In PH group,there was no significant correlation between PAC and IST,LVPWT,LVMI,LVEDD and LAD(all P>0.05).Multiple linear regression showed that urinary sodium in the PH group was an independent risk factor LVMI and LVEDD(P=0.005 and 0.006 respectively),there was no correlation between aldosterone level and cardiac structure.5.There was a significant positive correlation between 24 hours urinary sodium and LVEDD in PA group(P=0.049).The PAC in PA group was positively correlated with LVMI(P=0.007),but 24 hours urinary sodium were not significantly correlated to IST,LVPWT,LVMI,LVEDD and LAD(all P>0.05)。Multiple linear regression indicated that PAC was an independent risk factor for LVMI(P<0.05),and there was no correlation between urinary sodium and cardiac structure.Conclusion:1.For PH group,blood pressure,left ventricular hypertrophy and heart chamber size increased with the increase of urinary sodium,among which urinary sodium was an independent risk factor for LVMI and LVEDD.There was no significant correlation between PAC and cardiac structure in PH group.2.There was no significant correlation between urinary sodium and blood pressure,left ventricular hypertrophy and heart cavity size in PA group.The PAC in PA group was an independent risk factor for LVMI.