4.5 Review

Primary Aldosteronism, Aldosterone, and Extracellular Vesicles

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Summary: Extracellular vesicles play a role in the development and progression of hypertension, offering potential as a new area of research for identifying novel biomarkers and therapeutic targets in the field of hypertension.

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Intraindividual Variability of Aldosterone Concentrations in Primary Aldosteronism Implications for Case Detection

Nicholas Yozamp et al.

Summary: Patients with primary aldosteronism exhibit high variability in aldosterone concentrations and aldosterone-to-renin ratios, with many screening values falling below conventionally accepted diagnostic thresholds. By recalibrating the definition of a positive screen to include more liberal thresholds for aldosterone and the aldosterone-to-renin ratio, the diagnostic yield for primary aldosteronism may be substantially increased.

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Proteomic Profile of Urinary Extracellular Vesicles Identifies AGP1 as a Potential Biomarker of Primary Aldosteronism

Eric R. Barros et al.

Summary: This study evaluated the proteome of urinary extracellular vesicles (uEVs) from patients with primary aldosteronism (PA) and identified an upregulation of alpha-1-acid glycoprotein 1 (AGP1) in PA uEVs, suggesting AGP1 as a potential biomarker for PA. Additionally, the concentration of uEVs was positively correlated with urinary creatinine, and the size of uEVs in PA patients was smaller compared to the control group, indicating differences in uEV characteristics between the two groups.

ENDOCRINOLOGY (2021)

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Time-Dependent Risk of Atrial Fibrillation in Patients With Primary Aldosteronism After Medical or Surgical Treatment Initiation

Kyoung Jin Kim et al.

Summary: The risk of new-onset atrial fibrillation remains elevated up to 3 years in patients with primary aldosteronism compared with essential hypertension, especially peaking at 1 year, and gradually declining afterwards to levels comparable with essential hypertension. Monitoring for atrial fibrillation up to 3 years after treatment, particularly in patients who underwent adrenalectomy, may be necessary.

HYPERTENSION (2021)

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Characterization of Circulating Extracellular Vesicle Surface Antigens in Patients With Primary Aldosteronism

Jacopo Burrello et al.

Summary: EVs were found to potentially act as biomarkers of vascular inflammation and endothelial dysfunction in patients with PA. Specific EV surface signature could differentiate patients with PA from controls, and after PA treatment the profile became similar to patients with essential hypertension.

HYPERTENSION (2021)

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Characterization of pendrin in urinary extracellular vesicles in a rat model of aldosterone excess and in human primary aldosteronism

Fumika Ochiai-Homma et al.

Summary: The study demonstrates the correlation between pendrin levels in uEVs and human PA, suggesting that therapeutic interventions can attenuate pendrin abundance in patients with PA. The analysis of pendrin in uEVs, along with other proteins, may be useful in understanding the pathophysiology of hypertensive disorders.

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Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study

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MicroRNA-21 ablation exacerbates aldosterone-mediated cardiac injury, remodeling, and dysfunction

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