Abstract
Objective: In the present study, which confirmatory test was most useful for reflecting the severity of primary aldosteronism (PA) was determined by evaluating 24-h blood pressure (BP), urine albumin, left ventricular mass (LVM), and intima media thickness (IMT). Design and method: This study included 113 patients (80 PA and 33 non-PA hypertensive patients) who were admitted to Oita University Hospital and evaluated using ambulatory blood pressure monitoring (ABPM). First, casual blood pressure (BP) and ABPM parameters were compared between PA and non-PA patients. Second, patients were divided into PA-positive and PA-negative groups based on confirmatory tests including the saline infusion test (SIT), captopril challenge test (CCT), and oral salt loading test (OSLT), and casual BP and ABPM parameters were compared between the two groups. In addition, urine albumin excretion, LVM, and maximum IMT as markers of organ damage were compared between the two groups. Results: The ABPM parameters but not casual BP, were higher in PA patients than in non-PA patients (nocturnal SBP: 118.3 ± 1.6 mmHg, 107.6 ± 2.7 mmHg, p < 0.001; 24-h SBP: 123.4 ± 1.6 mmHg, 113.2 ± 2.6 mmHg, p < 0.001, respectively). Nocturnal and 24-h systolic BP (SBP) in OSLT-positive patients were significantly higher than in OSLT-negative patients (nocturnal SBP: 124.3 ± 3.2 mmHg, 114.4 ± 3.2 mmHg, p = 0.036; 24-h SBP: 129.2 ± 3.3 mmHg, 119.9 ± 3.0 mmHg, p = 0.044, respectively). ABPM parameters in other confirmatory tests were not different between the PA-positive and PA-negative groups. Urine albumin excretion in OSLT-positive patients was significantly higher than in the OSLT-negative patients (51.6 ± 22.5 mg/day and 3.0 ± 0.3 mg/day, p = 0.043). However, in other confirmatory tests, organ damage markers (such as LVM and IMT) were not different between the two groups. Conclusions: The OSLT is potentially useful not only for the diagnosis of PA but also for assessment of 24-h SBP and organ damage, as indicated by urine albumin excretion.
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