The following is a summary of “Circulating Plasma Concentrations of ACE2 in Primary Aldosteronism and Cardiovascular Outcomes” published in the December 2022 issue of Endocrinology & Metabolism by Wu et al.

Plasma concentrations of angiotensin-converting enzyme 2 (pACE2) have been independently linked to cardiovascular disorders. Patients with primary aldosteronism (PA) may have higher pACE2 concentrations, which might increase the risk of cardiovascular events.

For a study, researchers investigated the presence of pACE2 in 168 incident PA patients using an inception observational cohort. In peripheral blood mononuclear cells, the expression of ACE2, serine protease 2 (TMPRSS2), and metalloprotease 17 (ADAM17) were evaluated.

Those with incident PA and patients with essential hypertension (EH) both reported higher levels of pACE2 (47.04±22.06 vs. 46.73±21.06 ng/mL; P =.937). Age was negatively connected with greater pACE2 in PA patients (β = 2.15; P =.033) and positively correlated with higher blood potassium levels (β = 2.29; P =.024). Of the 72 patients who had surgical treatment for unilateral PA (uPA), 36 (50%) experienced clinical full hypertension remission following adrenalectomy (Primary Aldosteronism Surgery Outcome criteria). At follow-up, pACE2 decreased in surgically treated patients with (P< .001) or without (P =.006) hypertension remission, but the attenuation of pACE2 was not statistically significant in patients who received uPA (P =.085) and bilateral PA (P =.409) in combination with mineralocorticoid receptor antagonist (MRA). With a mean follow-up of 3.29 years, persistently increased pACE2 (>23 ng/mL) following targeted therapies was associated with cardiovascular events and all-cause death in PA patients (hazard ratio = 8.8; P=.04). In contrast to normotensive controls, TMPRSS2 messenger RNA (mRNA) expression was greater in uPA (P =.018) and EH (P =.038) patients; it also reduced following adrenalectomy (P< .001) patients.

In comparison to the normotensive group, PA and EH patients showed greater pACE2 and higher expression of TMPRSS2 mRNA. Following targeted therapies, persistently high pACE2 (>23 ng/mL) was linked with an increased risk of death and incident cardiovascular events.