Primary aldosteronism (PA) is the most common endocrine cause of arterial
hypertension. Despite the increasing incidence of hypertension worldwide, the
true prevalence of PA in hypertension was only recently recognized. The
objective of the work was to estimate the prevalence of PA in patients at
different stages of hypertension based on a newly developed screening-diagnostic
overnight test. This is a prospective study with hypertensive patients
(n=265) at stage I (n=100), II (n=88), and III
(n=77) of hypertension. A group of 103 patients with essential
hypertension without PA was used as controls. PA diagnosis was based on a
combined screening-diagnostic overnight test, the
Dexamethasone-Captopril-Valsartan Test (DCVT) that evaluates aldosterone
secretion after pharmaceutical blockade of angiotensin-II and
adrenocorticotropic hormone. DCVT was performed in all participants
independently of the basal aldosterone to renin ratio (ARR). The calculated
upper normal limits for post-DCVT aldosterone levels [3 ng/dl (85
pmol/l)] and post-DCVT ARR [0.32
ng/dl/μU/ml (9 pmol/IU)] from controls,
were applied together to establish PA diagnosis. Using these criteria PA was
confirmed in 80 of 265 (30%) hypertensives. The prevalence of PA was:
21% (21/100) in stage I, 33% (29/88) in stage
II, and 39% (30/77) in stage III. Serum K+
levels were negatively correlated and urinary K+ was
positively correlated in PA patients with post-DCVT ARR
(r=–0.349, p <0.01, and r=0.27, p <0.05
respectively). In conclusion, DCVT revealed that PA is a highly prevalent cause
of hypertension. DCVT could be employed as a diagnostic tool in all subjects
with arterial hypertension of unknown cause.
Primary aldosteronism (PA) is the most common cause of endocrine hypertension. The prevalence of hypertension is higher in patients with diabetes mellitus-2 (DM-2). Following the limited existing data, we prospectively investigated the prevalence of aldosterone excess either as autonomous secretion (PA) or as a hyper-response to stress in hypertensive patients with DM-2 (HDM-2). A total of 137 HDM-2 patients and 61 non-diabetics with essential hypertension who served as controls (EH-C) underwent a combined, overnight diagnostic test, the Dexamethasone–captopril–valsartan test (DCVT) used for the diagnosis of PA and an ultralow dose (0.3 μg) ACTH stimulation test to identify an exaggerated aldosterone response to ACTH stimulation. Twenty-three normotensive individuals served as controls (NC) to define the normal response of aldosterone (ALD) and aldosterone-to-renin ratio (ARR) to the ultralow dose ACTH test. Using post-DCVTALD and ARR from the EH-C, and post-ACTH peak ALD and ARR from the NC, 47 (34.3%) HDM-2 patients were found to have PA, whereas 6 (10.4%) HDM-2 patients without PA (DCVT-negative) exhibited an exaggerated aldosterone response to stress—a prevalence much higher than ever reported. Treatment with mineralocorticoid receptor antagonists (MRAs) induced a significant and permanent reduction of BP in all HDM-2 patients. Early diagnosis and targeted treatment of PA is crucial to prevent any aggravating effect on chronic diabetic complications.
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