Prevalence of primary aldosteronism in type 2 diabetes mellitus and hypertension: A prospective study from Western India.
Asian Indians
aldosterone
hyperaldosteronism
hypertension
prevalence
screening
type 2 diabetes mellitus
Journal
Clinical endocrinology
ISSN: 1365-2265
Titre abrégé: Clin Endocrinol (Oxf)
Pays: England
ID NLM: 0346653
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
revised:
24
08
2021
received:
17
07
2021
accepted:
09
09
2021
pubmed:
29
9
2021
medline:
21
4
2022
entrez:
28
9
2021
Statut:
ppublish
Résumé
Type 2 diabetes mellitus (T2DM) and hypertension commonly coexist; however, underlying primary aldosteronism (PA) can lead to worsening of hypertension, glycemia and cardiovascular risk. We aim to screen patients with T2DM and hypertension for PA by conducting a prospective monocentric study from Western India, which included adults with T2DM and hypertension from the outpatient diabetes clinic. Prospective study. Patients with an aldosterone renin ratio of ≥1.6 ng/dl/µIU/ml with plasma aldosterone concentration (PAC) ≥ 10 ng/dl were considered to be positive on a screening test. A PAC ≥ 6 ng/dl on seated saline suppression test (SST) was used to confirm the diagnosis of PA. Four hundred and eighty-six patients were included in this study. Seventy-six (15.6%, 95% confidence interval [CI]: 12.7%-19.1%) patients had a positive screening test with positive confirmatory test in 20 of the 36 (55.5%, 95% CI: 39.3%-71.7%) screen-positive patients who underwent SST. Patients with positive screening test had a higher proportion of females (65.8% vs. 50%; p = .011), frequent history of hypertensive crises (21.1% vs. 8%; p = .001), uncontrolled blood pressure (51.3% vs. 34.6%; p = .006), diagnosis of hypertension before diabetes (32.9% vs. 21.7%; p = .035) and higher systolic (137.6 ± 6.9 vs. 131.2 ± 17.8 mmHg; p = .004) and diastolic (85.3 ± 11.1 vs. 81.7 ± 10.7 mmHg; p = .007) blood pressures. Patients with positive confirmatory test had longer duration of diabetes (108 [60-162] vs. 42 [24-87] months; p = .012), hypertension (84 [42-153] vs. 36 [15-81] months; p = .038) and higher creatinine (1.16 [1.02-1.42] vs. 0.95 [0.84-1.12] mg/dl; p = .021). PA is prevalent (at least 4.1%) in Asian Indian patients with T2DM and hypertension. Further studies are needed to assess the cost-effectiveness of routine screening.
Substances chimiques
Aldosterone
4964P6T9RB
Renin
EC 3.4.23.15
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
539-548Informations de copyright
© 2021 John Wiley & Sons Ltd.
Références
Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889-1916.
Monticone S, D'ascenzo F, Moretti C, et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2018;6(1):41-50.
Monticone S, Burrello J, Tizzani D, et al. Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice. J Am Coll Cardiol. 2017;69(14):1811-1820.
Rossi GP, Bernini G, Caliumi C, et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol. 2006;48(11):2293-2300.
Brown JM, Siddiqui M, Calhoun DA, et al. The unrecognized prevalence of primary aldosteronism. Ann Intern Med. 2020;173(1):10-20.
Simonson DC. Etiology and prevalence of hypertension in diabetic patients. Diabetes Care. 1988;11(10):821-827.
Adler GK, Murray GR, Turcu AF, et al. Primary aldosteronism decreases insulin secretion and increases insulin clearance in humans. Hypertension. 2020;75(5):1251-1259.
Umpierrez GE, Cantey P, Smiley D, et al. Primary aldosteronism in diabetic subjects with resistant hypertension. Diabetes Care. 2007;30(7):1699-1703.
Mukherjee JJ, Khoo CM, Thai AC, Chionh SB, Pin L, Lee KO. Type 2 diabetic patients with resistant hypertension should be screened for primary aldosteronism. Diab Vasc Dis Res. 2010;7(1):6-13.
Tancredi M, Johannsson G, Eliasson B, et al. Prevalence of primary aldosteronism among patients with type 2 diabetes. Clin Endocrinol. 2017;87(3):233-241.
Jefic D, Mohiuddin N, Alsabbagh R, Fadanelli M, Steigerwalt S. The prevalence of primary aldosteronism in diabetic patients. J Clin Hypertens. 2006;8(4):253-256.
Hu Y, Zhang J, Liu W, Su X. Determining the prevalence of primary aldosteronism in patients with new-onset type 2 diabetes and hypertension. J Clin Endocrinol Metab. 2020;105(4):dgz293.
Murase K, Nagaishi R, Takenoshita H, Nomiyama T, Akehi Y, Yanase T. Prevalence and clinical characteristics of primary aldosteronism in Japanese patients with type 2 diabetes mellitus and hypertension. Endocr J. 2013;60(8):967-976.
Alam S, Kandasamy D, Goyal A, et al. High prevalence and a long delay in the diagnosis of primary aldosteronism among patients with young-onset hypertension. Clin Endocrinol. 2021;94(6):895-903.
Kumar A, Lall SB, Ammini A, et al. Screening of a population of young hypertensives for primary hyperaldosteronism. J Hum Hypertens. 1994;8(9):731-732.
Unnikrishnan R, Anjana RM, Mohan V. Diabetes in South Asians: is the phenotype different? Diabetes. 2014;63(1):53-55.
American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2021. Diabetes Care. 2021;44(suppl 1):S15-S33.
Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation. 2019;140(11):e596-e646.
Li N, Wang M, Wang H, et al. Prevalence of primary aldosteronism in hypertensive subjects with hyperglycemia. Clin Exp Hypertens. 2013;35(3):175-182.
Vaidya A, Carey RM. Evolution of the primary aldosteronism syndrome: updating the approach. J Clin Endocrinol Metab. 2020;105(12):3771-3783.
Young WF. Diagnosis and treatment of primary aldosteronism: practical clinical perspectives. J Intern Med. 2019;285(2):126-148.
Byrd JB, Turcu AF, Auchus RJ. Primary aldosteronism. Circulation. 2018;138(8):823-835.
Yozamp N, Hundemer GL, Moussa M, et al. Intraindividual variability of aldosterone concentrations in primary aldosteronism. Hypertension. 2021;77(3):891-899.
Funder JW. Primary aldosteronism: where are we now? Where to from here? Horm Metab Res. 2020;52(6):459-466.
Stowasser M, Ahmed AH, Cowley D, et al. Comparison of seated with recumbent saline suppression testing for the diagnosis of primary aldosteronism. J Clin Endocrinol Metab. 2018;103(11):4113-4124.
Song Y, Yang S, He W, et al. Confirmatory tests for the diagnosis of primary aldosteronism. Hypertension. 2018;71(1):118-124.
Feldman RD. Aldosterone and blood pressure regulation. Hypertension. 2014;63(1):19-21.
Akasaka H, Yamamoto K, Rakugi H, et al. Sex difference in the association between subtype distribution and age at diagnosis in patients with primary aldosteronism. Hypertension. 2019;74(2):368-374.
Gerards J, Heinrich DA, Adolf C, et al. Impaired glucose metabolism in primary aldosteronism is associated with cortisol cosecretion. J Clin Endocrinol Metab. 2019;104(8):3192-3202.
Okazaki-Hada M, Moriya A, Nagao M, Oikawa S, Fukuda I, Sugihara H. Different pathogenesis of glucose intolerance in two subtypes of primary aldosteronism: aldosterone-producing adenoma and idiopathic hyperaldosteronism. J Diabetes Investig. 2020;11(6):1511-1519.
Chen W, Li F, He C, Zhu Y, Tan W. Elevated prevalence of abnormal glucose metabolism in patients with primary aldosteronism: a meta-analysis. Ir J Med Sci. 2014;183(2):283-291.
Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol. 2018;6(1):51-59.
Kwak MK, Lee JY, Kim B-J, Lee SH, Koh J-M. Effects of primary aldosteronism and different therapeutic modalities on glucose metabolism. J Clin Med. 2019;8(12):2194.