Abstract
To study the differences in the prevalence, risk, and grade of control of different cardiometabolic comorbidities in patients with primary aldosteronism (PA) and essential hypertension (EH) matched by age, sex, and blood pressure levels at diagnosis. Case-control study of a secondary base (PA patients in follow-up in a tertiary hospital between 2018 and 2020). Controls were patients with non-functioning adrenal incidentalomas and EH, matched by age, sex, and baseline diastolic blood pressure (DBP) and systolic blood pressure (SBP). Fifty patients with PA and 50 controls were enrolled in the study. At diagnosis, PA patients had a higher prevalence of chronic kidney disease (CKD) than controls (18.4% vs. 2.1%, P = 0.008). No differences were detected in the prevalence of other cardiometabolic comorbidities nor in their degree of control (P > 0.05). All patients received antihypertensive medical treatment and 10 PA patients underwent unilateral laparoscopic adrenalectomy. After a median follow-up of 31.9 [IQR = 1.0-254.8] months, PA patients presented a greater degree of declination of kidney function than controls (average decrease in glomerular filtration rate (MDRD-4) -17.6 ± 3.1 vs. -2.8 ± 1.8 ml/min/1.73 m2, P < 0.001). There were no differences in the grade of SBP (P = 0.840) and DBP control (P = 0.191), nor in the risk of developing other comorbidities or in their degree of control. PA patients have a higher prevalence of CKD at the time of diagnosis when compared to EH matched by age, sex, and blood pressure levels. Furthermore, the risk of kidney function impairment throughout the follow-up is significantly greater in PA patients and is independent of the degree of blood pressure control.
Highlights
Primary aldosteronism (PA) is a condition that is a result of the autonomous excessive production of aldosterone that escapes regulation from angiotensin or plasma potassium concentrations [1]
After a median follow-up of 31.9 [IQR=1.0-254.8] months, PA patients presented a greater degree of declination of kidney function than controls (Average decrease in glomerular filtration rate (MDRD-4) -17.6±3.1 vs -2.8±1.8 ml/min/1.73m2, P
PA patients have a prevalence of chronic kidney disease (CKD) ten times higher than those with essential hypertension (EH) matched by age, sex, and blood pressure levels
Summary
Primary aldosteronism (PA) is a condition that is a result of the autonomous excessive production of aldosterone that escapes regulation from angiotensin or plasma potassium concentrations [1]. Current evidence regarding the link between PA and cardiometabolic risk independently of blood pressure levels is conflicting; some studies point towards an increased risk of metabolic syndrome [5] and cardiovascular and cerebrovascular events compared to patients with essential hypertension (EH) [3, 6] and others reporting no differences [7,8,9,10]. The aim of our study was to analyze the differences in the prevalence, risk during follow-up, and grade of control of the different cardiometabolic comorbidities in PA patients and controls with EH matched by sex, age, and blood pressure levels, and try to find out the question about the differences in the cardiometabolic risk in PA and EH patients after adjusting by possible confounding factors
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