Detection and management for primary aldosteronism in hypertensive subjects with diabetes mellitus

Abstract

Objective To explore the screening, positive rate and curative effect observation after special treatment for primary aldosteronism (PA) in hypertensive in-patients with diabetes mellitus. Methods One hundred and seventy-eight hypertensive in-patients with diabetes were screened for PA.Patients with aldosterone/renin acrivity ≥554 pmol/L·[μg/(L·h)]-1 were defined the positive screening group, and remains were the negative screening group.PA was considered according on plasma aldosterone concentration (PAC) ≥138.5 pmol/L and PA was defined with PAC≥277.0 pmol/L after saline infusion test in the positive screening group. Results The level of potassium [(3.7±0.4)mmol/L] in the positive screening group was lower than that [(3.9±0.4)mmol/L] in the negative group, and the difference was statistically significant (t=-3.40, P<0.01). The prevalence of PA ranged from 14.0% to 23.0% respectively, due to 41 PA patients with PAC≥138.5 pmol/L and 25 PA patients with PAC≥277.0 pmol/L.Twenty-three patients with PA accepted the adrenal vein sampling (AVS), the operative successful ratio was 91.3%, 6 patients were defined on unilateral adrenal PA, 3 patients accepted adrenalectomy, 2 patients with adrenal producing adenoma and one patient with unilateral nodule hyperplasia were identified via the pathological diagnose after surgery.Twenty-three patients with PA, who had been performed AVS, were followed up 1~2 years after having accepted surgery or mineralocorticoid receptor antagonist.The level of systolic blood pressure [(132.0±7.67)mmHg] after treatment was lower than that [(150.0±14.0)mmHg] before treatment, the difference was statistically significant (t=5.63, P<0.01). The level of diastolic blood pressure [(85.0±7.0)mmHg] after treatment was lower than that [(96.0±5.0)mmHg] before treatment, and the difference was statistically significant (t=5.16, P<0.01). The level of potassium [(4.0±0.3)mmol/L] after treatment was higher than that [(3.5±0.4)mmol/L] before treatment, and the difference was statistically significant (t=-5.45, P<0.01). Conclusion A considerable amount PA patients exist in hypertensive subjects with diabetes mellitus.Screening and management for PA are suggested in these patients and the curative effect is affirmed. Key words: Hypertension; Diabetes mellitus; Primary aldosteronism