Primary Aldosteronism in Diabetic Subjects With Resistant Hypertension

@article{citeulike:2208961, abstract = {OBJECTIVE-- Despite the high prevalence of hypertension in patients with type 2 diabetes, the prevalence of primary aldosteronism in this population has not been determined. RESEARCH DESIGN AND METHODS-- One hundred subjects with type 2 diabetes and resistant hypertension, defined as blood pressure >140/90 mmHg despite the use of [\&ge;]3 antihypertensive agents, were screened for primary aldosteronism. Screening was performed by measuring the plasma aldosterone (PAC)-to-plasma renin activity (PRA) ratio. Subjects with a PAC-to-PRA ratio >30 ng {middle dot} ml-1 {middle dot} h-1 underwent confirmatory salt load testing. Diagnostic criteria included 24-h urine aldosterone [\&ge;]12 {micro}g during the 3rd day of the oral salt load or a PAC [\&ge;]5 ng/dl after the 4-h intravenous saline load. RESULTS-- Thirty-four subjects had a PAC-to-PRA ratio >30 ng {middle dot} ml-1 {middle dot} h-1. Fourteen subjects (14\% [95\% CI 7.2-20.8]) had a confirmed diagnosis of primary aldosteronism. Ninety-three patients were African Americans. There were no differences in age, glycemic control, and number of antihypertensive drugs between subjects with and without primary aldosteronism. Subjects with primary aldosteronism had lower serum potassium (3.7 {+/-} 0.4 vs. 4.0 {+/-} 0.4 mmol/l, P = 0.012), higher PAC (15.6 {+/-} 8 vs. 9.1 {+/-} 6 ng/dl, P = 0.0016), and higher PAC-to-PRA ratio (98 {+/-} 74 vs. 21 {+/-} 30 {middle dot} ml-1 {middle dot} h-1, P < 0.001) than patients without primary aldosteronism. CONCLUSIONS-- Primary aldosteronism is common in diabetic patients with resistant hypertension, with a prevalence of 14\%. Our results indicate that diabetic subjects with poorly controlled hypertension who are taking [\&ge;]3 antihypertensive drugs should be screened for primary aldosteronism. 10.2337/dc07-0031}, author = {Umpierrez, Guillermo E. and Cantey, Paul and Smiley, Dawn and Palacio, Andres and Temponi, Diana and Luster, Karen and Chapman, Arlene }, citeulike-article-id = {2208961}, doi = {http://dx.doi.org/10.2337/dc07-0031}, journal = {Diabetes Care}, keywords = {diabetes, endocrinehypertension}, month = {July}, number = {7}, pages = {1699--1703}, posted-at = {2008-01-08 22:45:30}, priority = {2}, title = {Primary Aldosteronism in Diabetic Subjects With Resistant Hypertension}, url = {http://dx.doi.org/10.2337/dc07-0031}, volume = {30}, year = {2007} }

TY - JOUR ID - citeulike:2208961 L3 - citeulike-article-id:2208961 TI - Primary Aldosteronism in Diabetic Subjects With Resistant Hypertension JF - Diabetes Care VL - 30 IS - 7 SP - 1699 EP - 1703 N2 - OBJECTIVE-- Despite the high prevalence of hypertension in patients with type 2 diabetes, the prevalence of primary aldosteronism in this population has not been determined. RESEARCH DESIGN AND METHODS-- One hundred subjects with type 2 diabetes and resistant hypertension, defined as blood pressure >140/90 mmHg despite the use of [&ge;]3 antihypertensive agents, were screened for primary aldosteronism. Screening was performed by measuring the plasma aldosterone (PAC)-to-plasma renin activity (PRA) ratio. Subjects with a PAC-to-PRA ratio >30 ng {middle dot} ml-1 {middle dot} h-1 underwent confirmatory salt load testing. Diagnostic criteria included 24-h urine aldosterone [&ge;]12 {micro}g during the 3rd day of the oral salt load or a PAC [&ge;]5 ng/dl after the 4-h intravenous saline load. RESULTS-- Thirty-four subjects had a PAC-to-PRA ratio >30 ng {middle dot} ml-1 {middle dot} h-1. Fourteen subjects (14% [95% CI 7.2-20.8]) had a confirmed diagnosis of primary aldosteronism. Ninety-three patients were African Americans. There were no differences in age, glycemic control, and number of antihypertensive drugs between subjects with and without primary aldosteronism. Subjects with primary aldosteronism had lower serum potassium (3.7 {+/-} 0.4 vs. 4.0 {+/-} 0.4 mmol/l, P = 0.012), higher PAC (15.6 {+/-} 8 vs. 9.1 {+/-} 6 ng/dl, P = 0.0016), and higher PAC-to-PRA ratio (98 {+/-} 74 vs. 21 {+/-} 30 {middle dot} ml-1 {middle dot} h-1, P < 0.001) than patients without primary aldosteronism. CONCLUSIONS-- Primary aldosteronism is common in diabetic patients with resistant hypertension, with a prevalence of 14%. Our results indicate that diabetic subjects with poorly controlled hypertension who are taking [&ge;]3 antihypertensive drugs should be screened for primary aldosteronism. 10.2337/dc07-0031 KW - diabetes KW - endocrinehypertension AU - Umpierrez, Guillermo AU - Cantey, Paul AU - Smiley, Dawn AU - Palacio, Andres AU - Temponi, Diana AU - Luster, Karen AU - Chapman, Arlene PY - 2007/07/01/ UR - http://dx.doi.org/10.2337/dc07-0031 ER -