Comparison of Clinical Features between Primary Aldosteronism and Essential Hypertension in Chinese Patients: A Case-Control Study

Abstract

Primary aldosteronism (PA) is one of the most common forms of secondary hypertension. Recent studies suggest that, compared with essential hypertension (EH), PA presents more severe disorders of glycolipid metabolism and organ damages. This case-control retrospective study aimed to ascertain clinical features and metabolic parameters between Chinese patients of PA and EH. 174 PA patients and 174 matched EH patients were recruited. Their clinical features, biochemistry parameters, the ventricular septal thickness, and left ventricular mass index (LVMI) were compared. HOMA-β% and HOMA-IR were calculated to evaluate glucose metabolism. The results showed that there was no significant difference regarding BMI, waist-to-hip ratio, and blood pressure between the two groups. The blood potassium level was significantly lower in PA patients than those in EH patients. The abnormal glucose tolerance and the incidence of diabetes in the PA group were not significantly different from those in EH group, but the insulin secretion levels at 0 min and 30 min were significantly weaker than those in the EH group, and the HOMA-β% was also lower in the PA group than those in the EH group. Left ventricular structural abnormalities in PA patients were more severe than those in EH patients. Subtype analysis indicated that patient with aldosterone-producing adenoma (APA) has more serious hypokalemia and lower levels of HOMA-β% and HOMA-IR comparing to those in the idiopathic adrenal hyperplasia (IHA) patient. These findings demonstrated that PA patients showed more impaired insulin secretion function and more severe left ventricular structural damage compared with EH patients.

Differences in Glycemic Abnormalities Between Primary Aldosteronism and Essential Hypertension: A Systematic Review and Meta-Analysis

“…One study did not provide data on sex ( 47 ). Nineteen studies were matched for demographic data ( 13 , 14 , 26 , 27 , 30 – 36 , 38 , 39 , 41 – 45 , 47 ). Regarding outcomes, 15 studies provided data on the prevalence of DM ( 2 , 13 , 14 , 27 – 29 , 31 , 32 , 34 , 35 , 37 – 39 , 47 , 48 ), 4 studies on IFG ( 2 , 14 , 35 , 40 ) and 5 studies on IGT ( 25 , 28 , 35 , 36 , 47 ).…”

“…Regarding outcomes, 15 studies provided data on the prevalence of DM ( 2 , 13 , 14 , 27 – 29 , 31 , 32 , 34 , 35 , 37 – 39 , 47 , 48 ), 4 studies on IFG ( 2 , 14 , 35 , 40 ) and 5 studies on IGT ( 25 , 28 , 35 , 36 , 47 ). Twenty studies included data on FBG ( 2 , 14 , 25 , 27 , 28 , 30 , 32 , 34 – 38 , 40 – 47 ) with 10 studies excluded DM patients or discontinuing hypoglycemic agents before recruitment ( 25 , 30 , 36 , 40 – 46 ), 7 on HbA1c ( 13 , 25 , 26 , 30 , 31 , 36 ), 5 on 2-hr OGTT ( 25 , 30 , 32 , 36 , 47 ), 10 on HOMA-IR ( 25 , 26 , 28 , 30 , 33 , 36 , 41 – 44 ), 5 on HOMA-ß ( 26 , 30 , 33 , 43 , 45 ), 3 on AUC of glucose ( 25 , 26 , 45 ), 4 on AUC of insulin ( 25 , 26 ...…”

“…Risk of bias was assessed using JBI tools for cohort, case-control and cross-sectional studies ( Table 1 ) . Most of the studies (22 of 27) evidenced high quality with a low risk of bias ( 2 , 13 , 14 , 26 – 28 , 30 – 33 , 35 , 36 , 38 – 44 , 46 – 48 ). The other five studies ( 25 , 29 , 34 , 37 , 45 ) showed moderate quality with a moderate risk of bias due to 1) important confounders not being identified and appropriately controlled for by proper statistical analyses for cross-sectional studies and 2) not being evaluated regarding the outcomes issues as measured outcomes were not relevant to the primary objectives of the current study for cohort studies.…”

The differences of serum lipid profiles between primary aldosteronism and essential hypertension: a meta-analysis and systematic review

“…The full texts of the remaining 79 articles were retrieved and reviewed resulting in the exclusion of 49 articles due to various reasons. A total of 30 studies were finally included [ 10 – 15 , 29 – 52 ]. There was excellent inter-reviewer agreement (κ = 0.82; 95% CI, 0.71–0.92).…”

“…One study excluded patients with severe hyperlipidemia [ 34 ]. All but one [ 29 ] of the studies provided data on TG levels, 27 included data on TC [ 10 – 15 , 29 , 31 , 33 – 50 , 52 ] and HDL levels [ 10 – 15 , 29 – 36 , 38 – 41 , 43 , 45 – 52 ] and 25 provided LDL levels [ 10 – 15 , 29 , 31 , 33 – 36 , 38 – 41 , 43 , 45 – 52 ].…”