CARDIOVASCULAR COMPLICATIONS IN PATIENTS WITH PRIMARY HYPERALDOSTERONISM: A CONTROLLED CROSS-SECTIONAL STUDY: PP.18.178

Abstract

Objective: A much higher risk of cardiovascular events has been reported in patients with primary aldosteronism (PA) than in otherwise similar patients with essential hypertension (EH). However, the evidence is limited by small sample size and inadequate analysis. Design and Methods: All patients with PA diagnosed in a hypertension unit between 2001 and 2006 were included. These 460 patients were retrospectively compared to 1291 patients with EH in whom PA had been ruled out and individually matched for sex, age [± 2 years] and office systolic blood pressure (SBP) [± 10 mmHg]. Clinical and ECG data had been collected during the first in-patient assessment. Odds ratios were computed with conditional logistic regression, interactions with gender and PA subtype were systematically tested. Results: The proportion of men was 66%, mean age was 51 years and mean SBP 150 mmHg. Patients with PA had a longer history of hypertension (10.8 vs 8.5 years) than those with EH. Treatment intensity was similar in both groups (75% patients on antihypertensive medication with an average of 2.3 drug classes), as were body mass index (28 kg/m2) and the prevalence diabetes (15%). The prevalence of cardiovascular complications in patients with PA and their controls are reported in the Table. Odds ratio were not significantly changed after adjusting for hypertension duration. Interaction tests did not reveal significant differences in the prevalence odds ratios according to gender or PA subtypes. Conclusion: Although cardiovascular complications were more frequent in patients with PA than in those with EH, the absolute prevalence and the difference with matched controls were less than previously reported. Better control of hypertension and other cardiovascular risk factors in primary prevention might explain this trend. The remaining risk excess might be due to a direct effect of hyperaldosteronism on target organs or to unmeasured hemodynamic confounders (as higher night-time blood pressure levels).