Prevalence and clinical characteristics of primary aldosteronism in Japanese patients with type 2 diabetes mellitus and hypertension

Abstract

The prevalence of primary aldosteronism (PA) is around 3-15% in patients with hypertension. Hypertension is a frequent complication of type 2 diabetes mellitus (DM) because of the close etiological relationship between these two diseases. However, the possibility of PA in patients with DM and hypertension is often overlooked and the prevalence of PA in patients with DM and hypertension in Japan is unknown. We enrolled 124 hospitalized patients with both DM and hypertension. PA was diagnosed according to the modified criteria for Japanese patients. We examined the prevalence of PA and compared clinical characteristics between patients with and without PA. In another analysis of 43 patients with a confirmed diagnosis of PA, we compared the characteristics of patients with and without DM. Overall, 14/124 patients with DM and hypertension (11.3%) were diagnosed with PA. Multivariate logistic regression showed that the duration of DM was significantly shorter in the PA group. Fisher's direct probability test revealed that history of hypertension before the diagnosis of DM was a significant factor in patients with PA. Treatment with an angiotensin II receptor blocker (ARB) did not affect the diagnosis of PA in these patients. Among 43 patients with PA, those with DM were significantly older and the delay to the diagnosis of PA was significantly longer compared with patients without DM. In conclusion, almost 10% of patients with DM and hypertension actually have PA. More extensive screening for PA is recommended in patients with DM and hypertension, regardless of the use of ARBs.

Prevalence of primary aldosteronism among patients with type 2 diabetes

“…The present study adds to earlier findings that have shown an association between PA at the clinical level to the metabolic syndrome and various mechanisms between hyperaldosteronism and insulin action . However, in line with earlier studies, clinicians should be alert to considering screening for PA if hypertension (especially resistant) or hypokalaemia exists. Moreover, as earlier studies have shown that high aldosterone levels have been associated with cardiovascular disease, it may also be concluded that high ARR or aldosterone levels do not seem to be strong risk factors for either micro‐ or macrovascular complications in our population of type 2 diabetes patients.…”

“…PA is considered the most common cause of secondary hypertension . In contrast to the present study, three other studies of PA and type 2 diabetes only included patients with resistant hypertension and found higher prevalence of PA.…”

“…27 In a study of 100 consecutive patients with type 2 diabetes and hypertension in Singapore, the prevalence of PA was 13%. 28 A possible explanation for discrepancies in findings between the present and other studies is differences in study designs.…”

“…Furthermore, differences in methodologies and ethnicities of the cohorts were observed. One essential difference in methodology is that in other studies, all patients with increased ARR generally underwent further confirmatory tests for PA . In the current study, only those who were judged clinically indicated in line with guidelines for diagnosis of PA were further evaluated.…”

Aldosterone and the mineralocorticoid receptor in insulin resistance and diabetes

“…However, the possibility of primary aldosteronism in patients with T2DM and hypertension is often overlooked, in part because hypertension is often attributed to other risk factors commonly encountered in T2DM patients. The prevalence of primary hyperaldosteronism in subjects with T2DM and uncontrolled or resistant hypertension ranges from 11% to 24% in different populations [63][64][65] . This evidence highlights the relevance of screening for hyperaldosteronism in T2DM, especially when there is resistant hypertension, mild or overt hypokalemia or family history or hyperaldosteronism 66,67 .…”