Type 2 diabetic patients with resistant hypertension should be screened for primary aldosteronism

BP control in diabetic patients is often poor. The contribution of secondary hypertension due to undiagnosed PA in hypertensive type 2 diabetic patients is not well studied. We prospectively screened 100 consecutive Asian type 2 diabetic patients with difficult-to-control or resistant hypertension f...

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Published in:Diabetes & vascular disease research 2010-01, Vol.7 (1), p.6-13
Main Authors: Mukherjee, J.J., Khoo, C.M., Thai, A.C., Chionh, S.B., Pin, Lim, Lee, K.O.
Format: Article
Language:English
Subjects:
Aged
Antihypertensive Agents - therapeutic use
Asian Continental Ancestry Group - statistics & numerical data
Comorbidity
Diabetes Mellitus, Type 2 - diagnosis
Diabetes Mellitus, Type 2 - ethnology
Drug Resistance
Female
Humans
Hyperaldosteronism - diagnosis
Hyperaldosteronism - ethnology
Hypertension, Renal - diagnosis
Hypertension, Renal - drug therapy
Hypertension, Renal - ethnology
Male
Mass Screening
Middle Aged
Prevalence
Risk Factors
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Summary:BP control in diabetic patients is often poor. The contribution of secondary hypertension due to undiagnosed PA in hypertensive type 2 diabetic patients is not well studied. We prospectively screened 100 consecutive Asian type 2 diabetic patients with difficult-to-control or resistant hypertension for PA. PAC (pmol/L) to PRA (ng/mL/h) ratio was measured; those with PAC-to-PRA ratio >550 (corresponding PAC >415) underwent intravenous 0.9% SLT. Patients with PAC ≥140 following SLT had CT adrenals and bilateral AVS. Thirteen patients (13%) were confirmed to have PA, and all had resistant hypertension. Eight had a surgically correctable form of PA. Patients with PA had higher mean (SD) systolic [159.0 (10.6) vs. 146.0 (10.7) mmHg, p=0.001] and diastolic BP [94.6 (6.0) vs. 87.6 (5.9) mmHg, p=0.001], lower serum potassium [3.5 (0.6) vs. 4.3 (0.5) mmol/L, p=0.001], and higher PAC [679.3 (291.0) vs. 239.5 (169.4) pmol/L, p=0.001]. Identification and institution of definitive treatment for PA resulted in better BP control and in a reduction in the use of antihypertensive medications. Our findings demonstrate a high prevalence of PA in type 2 diabetic patients with resistant hypertension. Systematic screening for PA in this select group is recommended, as targeted treatment improves BP control.
ISSN:1479-1641
1752-8984
DOI:10.1177/1479164109350556