Aim: This study investigated vascular alterations in patients with primary aldosteronism (PA), using speckle-tracking carotid strain (STCS) ultrasonography, which allows simultaneous assessment of arterial structure and function. It also aimed to compare arterial stiffness and strain changes over follow-up between surgical and mineralocorticoid receptor antagonist (MRA) treatments.

Methods: All patients underwent standardized diagnostic work-up for PA. STCS ultrasonography was performed at baseline and 6 months post-treatment. A 5-mm segment of the common carotid artery below the bulb was analyzed to quantify arterial compliance and distensibility (reflecting elasticity); elastic modulus, β-stiffness index and pulse wave velocity (PWV) (reflecting stiffness); and strain-related parameters: displacement, strain and strain rate.

Results: Thirty patients were included. Arterial compliance increased in both transverse and longitudinal planes in the overall cohort (p<0.05). Between-group comparison revealed greater improvement in arterial compliance in the surgical than in the medical group (p=0.033). Arterial distensibility also increased in the transverse plane (p<0.05), whereas no significant changes were observed in β-stiffness index, elastic modulus, PWV, or strain parameters (p>0.05). Carotid intima–media thickness (CIMT) significantly decreased after treatment in the overall cohort and medical group (p<0.05). Multivariate linear regression identified younger age, shorter hypertension duration, male gender and surgical treatment as independent predictors of greater post-treatment improvement in arterial compliance (p<0.05).

Conclusion: These findings suggest that STCS may be a feasible tool for assessing treatment-related vascular changes in PA. Arterial compliance improved following treatment, and more particularly after adrenalectomy, while structural stiffness was largely unchanged in this exploratory comparison.