The Blood Plasma Aldosterone Concentration in Stage II Hypertension Patients with Comorbid Chronic Coronary Artery Disease, Frequent Ventricular Extrasystoles and Different Clinical Indicators

Abstract

Introduction. Hypertensive disease (HD) remains a leading cause of death worldwide. Aldosterone is involved in the regulation of blood pressure, has proarrhythmic effects, and can induce myocardial fibrosis, contributing to myocardial electrical instability. The aim of the study. To assess the plasma aldosterone concentration variations in stage II hypertension patients with comorbid chronic coronary artery disease, frequent ventricular extrasystoles and different clinical indicators.Materials and methods. We examined 120 stage II HD patients (34 (28.3 %) women and 86 (71.7 %) men aged 34 to 74 (mean age of the examined patients - 57.3 ± 0.9 years)) with/and without concomitant chronic coronary insufficiency (CCI), frequent ventricular extrasystoles treated at the municipal institution "Vinnytsia Regional Medical and Diagnostic Center of Cardiovascular pathology". The study was a randomized one with preliminary stratification by stage II HD diagnosis. The ethylenediaminetetraacetic acid (EDTA) plasma aldosterone concentration (blood collected in EDTA tubes) was measured by enzyme-linked immunosorbent assay (ELISA) using a commercial kit "Aldosterone ELISA" (Dia Metra, Italy) according to the manufacturer’s instructions. The disease history was: HD - 8.6 ± 6.0, CCI - 4.8 ± 2.6, and arrhythmia - 3.5 ± 3.0 years. The majority (60.8 %, n = 73) of the examined patients had short hypertensive anamnesis not exceeding 10 years. 24.2 % (n = 29) of the patients had the history ranging from 10 to 15 years and only 15.0 % (n = 18) of the subjects had the history ex-ceeding 15 years. Taking into account the diagnosis of concomitant CCI and frequent ventricular extrasystoles, the study was divided into four separate groups: 1-st one (n=30, mean age 52.1 ± 11.1) consisting of HD patients without concomitant CCI and ventricular extrasystoles, 2-nd one (n = 30, mean age 53.9 ± 7.7) included HD patients with frequent ventricular extrasystoles, 3-rd group (n = 30, mean age 61.7 ± 7.5) involved HD patients with concomitant CCI, and the 4-th group (n = 30, mean age 61.6 ± 8.1) consisted of HD patients with concomitant CCI and frequent ventricular extrasystoles. The obtained results were statistically processed by variational statistics methods using Microsoft Excel (2019) and Statistica 12.0 (Statsoft, USA). The values were presented as n (%)- absolute number (percentage) and M ± σ - mean value ± standard deviation of the mean. Results. We used the method of variational statistics to find out that plasma aldosterone concentration in the total cohort of patients (n = 120) varied from 42.8 to 285.0 pg/ml, with an average of 158.1 ± 55.5 pg/ml. Due to abnormal distribution of the indicator in the sample calculated by the S. S. Shapiro-M. V. Wilk test (W = 0.92, p = 0.04), the results were presented as median and interquartile range (25-th - 75-th percentiles), 152.5 pg/ml and 116.5-204.5 pg/ml, respectively. For analytical comparison, the aldosterone result was dichotomized around the median. The rounded median value (153.0 pg/ml) was taken to distinguish groups with relatively small (≤153.0 pg/ml) and relatively large marker content (>153.0 pg/ml) in the examined cohort of patients (hereinafter RSC and RLC). The results of the study show that the plasma aldosterone concentration in 50.0 %, 25.0 %, and remaining 25.0 % of patients was within the range of 116.5-204.5 pg/ml, less than 116.5 pg/ml and over 204.5 pg/ml, respectively. Conclusions. We established that stage II hypertension patients with / without concomitant chronic coronary disease and frequent ventricular extrasystoles (n = 120) had the average plasma aldosterone concentration 158.1 ± 55.5 pg/ml (median - 152.5, interquartile range 116.5 and 204.5 pg/ml, espectively). The rounded value of the median indicator (153.0 pg/ml) was taken to distinguish groups with relatively low (≤153.0 pg/ml) and a relatively high concentration of the marker (>153.0 pg/ml) in the total cohort of patients. The obtained data suggest that significantly higher plasma aldosterone concentration was found in middle-aged and elderly patients compared to young patients, in case of hypertension history over 10 years, in patients with constitutional-alimentary obesity (body mass index >30.0 kg/m2), in groups of patients with concomitant chronic coronary artery disease, in patients diagnosed concomitant chronic coronary artery disease and frequent ventricular extrasystoles in the general sample of patients with stage C disease according to the Heart Failure Society of America. The association between aldosterone concentration and administration of such classes of medicines as Angioten-sin-converting enzyme inhibitors, sartans, thiazide and thiazide-like diuretics, antiplatelet and antilipid agents, and the number of antihypertensive medicines was found.