PURPOSE: Pulmonary Arterial Hypertension (PAH) is associated with alteration of neurohormonal factors such as endothelin, serotonin, thromboxane, and brain natriuretic peptide (BNP). The contribution of aldosterone to PAH remains unexplored.
METHODS: After obtaining institutional approval, aldosterone and BNP levels were collected and correlated with walk distance, functional class, and echocardiographic parameters in PAH patients followed at Baylor PH Center. As the upper level of normal for aldosterone level is 31 ng/dL, patients were characterized as having normal aldosterone (N-Aldo) (< 31 ng/dL) or high aldosterone (Hi-Aldo) (>31 ng/dL). The normal BNP level at our institution was 0-100 pg/ml.
RESULTS: Preliminary data from 19 PAH patients was reviewed. Eleven out of the nineteen patients had elevated aldosterone levels. Mean age of the patients in the N-Aldo group was 39±13 and in the Hi-Aldo group was 49±11 (mean±SD). There was one male in the N-Aldo and all females in the Hi-Aldo group. In N-Aldo group, the mean aldosterone level was 10±9, and in Hi-Aldo group, the mean level was 104±114 (P<0.007). In the N-Aldo group, six out of eleven patients had elevated BNP level (50%). In the Hi-Aldo group, six out of eight patients had elevated BNP level (73%). The walk distance in N-Aldo group was 394±112 and in the Hi-Aldo group was 318±103 (P<0.118). The functional class was slightly worse in the Hi-Aldo group (Table 1). The echocardiographically determined right heart parameters obtained at the same time showed similar parameters between the two groups (Table 1).
CONCLUSION: These results suggested that aldosterone level was elevated in a sub-group of PAH patients. Hi-Aldo group had higher BNP levels and lower walk distance suggesting a relationship between aldosterone levels and more severe or progressive PAH.
CLINICAL IMPLICATIONS: Aldosterone may emerge as a new biomarker that correlates with disease severity. A prospective clinical trial will be required to establish this finding.
DISCLOSURE: Zeenat Safdar, None.