Primary aldosteronism as a determinant of cardiovascular remodeling

Abstract

Objective: To analyze the structural cardiovascular repercussions of primary aldosteronism, with emphasis on imaging findings, pathophysiological mechanisms, and the effects of adrenalectomy on myocardial and vascular remodeling. Methods: This integrative literature review adopted a descriptive and qualitative approach. Searches were conducted in PubMed, Virtual Health Library (VHL), SciELO and Cochrane Library databases. The guiding question was structured according to the PICO strategy, considering patients with primary aldosteronism, cardiovascular structural alterations, comparison with essential hypertension or healthy controls, and outcomes related to hypertrophy, fibrosis and cardiac remodeling. Original studies published between 2020 and 2025 in Portuguese, English and Spanish were included, resulting in 10 eligible articles. Results: The final sample comprised 4,130 participants. Patients with primary aldosteronism showed higher rates of left ventricular hypertrophy, myocardial fibrosis, biventricular remodeling, arterial stiffness and microvascular dysfunction compared with individuals with essential hypertension. Structural abnormalities were also identified in subclinical stages of the disease. Furthermore, follow-up studies demonstrated partial reversal of cardiovascular damage after specific treatment, particularly following adrenalectomy. Conclusion: Primary aldosteronism promotes cardiovascular injury beyond the effects of elevated blood pressure alone. Early diagnosis and targeted treatment contribute to reverse structural cardiac and vascular changes, improving long-term cardiovascular outcomes.