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

Mukherjee, J. J.; Khoo, Chin Meng; Thai, A C; Chionh, Siok Bee; Pin, Lim; Lee, Kok-Onn

doi:10.1177/1479164109350556

Cited by 33 publications

(33 citation statements)

References 46 publications

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“…The prevalence of PA in this study was significantly lower than that demonstrated in other worldwide studies reported in the past twenty years (7,(14)(15)(16)(17)(18)(19)(20). This may be attributable to several factors.…”

Section: Discussioncontrasting

confidence: 55%

“…Since the validation of the aldosterone: renin ratio (ARR) as a reliable method for identifying PA, several global studies have reported PA prevalence rates ranging from 3-22% (7-14) with even higher rates reported (13-33%) in certain sub-populations, such as those with resistant hypertension and hypertension associated with diabetes or obstructive sleep apnea (15)(16)(17)(18)(19)(20). These findings may justify broader criteria for screening for PA.…”

Section: Introductionmentioning

confidence: 98%

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Prevalence of Primary Aldosteronism in an Urban Hypertensive Population

Galati¹,

Cheesman²,

Springer-Miller³

et al. 2016

Endocrine Practice

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Abstract:Objective: To determine the prevalence of Primary Aldosteronism (PA) in hypertensive patients presenting to the primary care clinic at The Mount Sinai Hospital, regardless of the degree of hypertension and to identify clinical criteria that should prompt screening for PA.Methods: An ARR (cutoff ≥20, with PAC ≥ 10 and suppressed renin) was used to prospectively screen 296 hypertensive patients (BP ≥ 140/90) over the age of 18 from August 2012 through May 2013.Subjects who screened positive then underwent confirmatory oral salt load testing (OSLT).Results: Of the 296 patients, fourteen screened positive for PA, an overall prevalence of 4.7%. Six of the fourteen cases underwent confirmatory OSLT upon which two confirmed positive, prevalence of 0.7%.Overall, patients with confirmed PA were more likely to have resistant hypertension (42.9% vs. 18.1% (p= 0.0334)) and require more anti-hypertensive agents (2.8 ±1.2 agents vs 2.1 ± 1.1 agents (p=0.0213)).There was a trend toward lower potassium values in the cases.Conclusion: The prevalence of PA in our clinic is much lower than in reports from certain "at-risk" populations. PA screening is indicated in patients with resistant hypertension, regardless of serum potassium levels. Introduction:

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Section: Discussioncontrasting

confidence: 55%

Section: Introductionmentioning

confidence: 98%

Prevalence of Primary Aldosteronism in an Urban Hypertensive Population

Galati¹,

Cheesman²,

Springer-Miller³

et al. 2016

Endocrine Practice

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“…However, another study was not able to con fi rm the association between metabolic syndrome and PA [ 68 ] . Finally, a recent retrospective study from the German Conn's Registry, showed that PA patients displayed a higher rate of diabetes compared to a control population of essential hypertensives [ 69 ] and others reported a high prevalence of PA in type 2 diabetic patients with resistant hypertension [ 70,71 ] .…”

Section: Clinical Features and Complications Of Pamentioning

confidence: 97%

Primary Aldosteronism: Progress in Diagnosis, Therapy, and Genetics

Mulatero

Williams

Monticone

et al. 2012

Endocrine Hypertension

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Primary aldosteronism (PA) is the most frequent cause of secondary hypertension and its prevalence increases with the severity of hypertension. The importance of PA diagnosis is not just related to offering a targeted treatment, that is, adrenalectomy, for aldosterone-producing adenoma and medical therapy with mineralocorticoid receptor antagonists for bilateral adrenal hyperplasia, but also because it has been demonstrated extensively that patients affected by PA are more susceptible to cardiovascular events and target organ damage compared to essential hypertensives. Herein, we review the pathophysiology of PA and its clinical features and potential complications; the three step approach employed in the diagnosis of PA, established by the Endocrine Society Guidelines, that is, screening, con fi rmation/exclusion, and subtype diagnosis are discussed; the rarer, familial, and sporadic genetic forms of PA are explained and we conclude with a section on targeted PA therapy.

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“…PA caused by aldosteroneproducing adenoma or unilateral adrenal hyperplasia shows an increasing trend, with a reported prevalence of around 20% in resistant hypertensive patients [12], and the incidenceis higher in patients with Type 2 DM [13]. Maintained hypervolemia plays a key role in remaining resistant.…”

Section: ) Primary Aldosteronism (Pa)mentioning

confidence: 99%

Progression in Diagnosis and Treatment of Resistant Hypertension

He¹,

Mu²,

Liu³

et al. 2014

J Cardiovasc Med Cardiol

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Introduction: Resistant Hypertension (RH) is a major risk factor of numerous diseases. RH is a challenging clinical problem,many factors affect blood pressure (BP) control. Correct diagnosis and appropriate drug therapy are pretty important to get BP controlled. We aim to attract physicians' attention to adopt correct measures to diagnose and treat RH.Method: Articlesare obtained from the Internet, www.pubmed.com, Medline and several authors via e-mail.Result and Conclusion: 1.Using a systematic approach to find out the causes of RH and the distinctions between pseudo-resistance and true resistance areof importance for treatment. 2. Following the current treatment guidelines and using the standardized way to establish a flowchart to manage the patientsare the correct methods for BP control. 3. In the absence of novel antihypertensive drugs targeting new pathways, device-based therapies including RDN, carotid baroreflex activation and continuous positive airway pressure (CPAP) have shown encouraging results. 4. Further efforts on the pathophysiology of RH will help to establish better drug combinations or new ways on BP control. and treatment of RH to attract physicians' attention to adopt correct measures to diagnose and treat RH. Discussion PrevalenceStrictly speaking, RH is not a definition of disease, but of management. So it is difficult to get its correct prevalence. Because of this, its prevalence is still unclear. Some large-scale clinical trials intended to figure out the prevalence of RH in overall population and hypertensive populationare shown below.According to the latest data from ESH/ESC [1], the prevalence of RH is around 5%-30% of the overall hypertensive populationwithfigures less than 10% probably representing the true prevalence. Arepresentative survey carried out by American National Health and Nutrition Examination [2] including > 15 000 non-pregnant adults between 2003 and 2008 found that resistant hypertension criteria were met in 8.9% of all individuals with hypertension, and in 12.8% of the hypertensive drugs treated population. A complete database for 7.9 years from Olivetti Heart Study (OHS) in southern Italy [3] showed that the prevalence of RH was 4.8% in the whole study population, and 10.1% in hypertensive participants. It seems that the prevalence ofRHis around 10% in hypertensive population, butsituations including treatment adherence, white coat hypertension and secondary hypertension were not reported. Another more detailed research by Stacie et al [4] demonstrated thatafter the exclusion of those who lost baseline data or failed to adhere to the research, the inadequate number of antihypertensive drugs, and poor medication adherence,the prevalence of true RH was only 1.9%among 205750 patients. It is, Abbreviations

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

Cited by 33 publications

References 46 publications

Prevalence of Primary Aldosteronism in an Urban Hypertensive Population

Prevalence of Primary Aldosteronism in an Urban Hypertensive Population

Primary Aldosteronism: Progress in Diagnosis, Therapy, and Genetics

Progression in Diagnosis and Treatment of Resistant Hypertension

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