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

Abstract

BackgroundThe relationship of glycemic abnormalities between primary aldosteronism (PA) patients and essential hypertension (EH) patients is still debatable. This meta-analysis aimed to explore differences in the prevalence of glycemic abnormalities and levels of abnormal glucose metabolism in PA and EH patients.MethodsA search was performed using PubMed, Scopus, Cochrane and Web of Science databases from their inception through January 2022. Inclusion criteria for this study were 1) observational studies which contained specific data of interest, 2) studies including data which compared adult PA and EH patients and 3) studies which used appropriate methods to diagnose PA. Risk ratio (RR) or standardized mean difference (SMD) with a 95% confidence interval (95% CI) was calculated.ResultsTwenty-six studies involving 53,186 patients were included in the meta-analysis. Patients with PA demonstrated significantly higher overall incidence of glycemic abnormalities than patients with EH [RR 1.54; 95% CI (1.20,1.98)]. Risk of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in PA patients were higher than in EH patients [RR 1.27; 95%CI (1.08, 1.49) and RR 2.99; 95%CI (1.74, 5.16), respectively]. There was no statistically significant difference of risk between these groups for impaired fasting glucose (IFG) [RR 1.70; 95%CI (0.55, 5.26)]. Moderate heterogeneity was observed in overall glycemic abnormalities outcomes. A high level of heterogeneity was observed for IFG, while the level was low for DM and IGT.ConclusionsPA patients have a higher risk of glycemic abnormalities than in EH patients. Further study should be conducted to investigate underlying mechanisms of glycemic abnormalities in PA.Systematic Review Registrationwww.inplasy.com, INPLASY, identifier 202220004.

Prevalence and impact of diabetes and prediabetes on presentation and complications of primary hyperaldosteronism at diagnosis

“…Studies conducted in several countries have reported prevalence of diabetes in patients with PH ranging between 15.2%-23%[ 3 , 5 , 11 , 15 ]. Two prior meta-analyses reported 1.54-1.55-fold higher risk of glycemic abnormalities with lower marker of insulin secretion and higher insulin resistance in PH compared to essential hypertension (EH)[ 15 , 16 ]. In our PH patients at presentation, we observed high prevalence of diabetes (37.2%) and prediabetes (24.3%), possibly due to higher risk of diabetes in Asian Indian population caused by altered lifestyle, increased visceral fat and insulin resistance with dyslipidaemia[ 17 ].…”

The prevalence of metabolic syndrome in primary aldosteronism and essential hypertension: A systematic review and meta‐analysis

“…There was excessive auto-secretion of aldosterone in patients with PA, leading to a series of disorders, including metabolic-associated diseases. 3,[5][6][7][8][9][10] As a group of complex metabolic disorder syndrome, MS was a risk factor of cardiovascular disease and also one of the hot spots in PA research. 27 Excessive aldosterone could contribute maturation and dysfunction of adipocytes by combining with…”

“…However, the results were uncertain. 7,9,10 As a series of disorganized metabolism, metabolic syndrome (MS) is defined including obesity, elevated BP, glucose metabolism disorders and dyslipidemia. 11 It is evaluated and diagnosed by these indicators: waist circumference (WC), fasting plasma glucose (FPG), BP, triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C).…”

“…The prevalence of glucose and lipid metabolism disorder in patients with PA and EH had been explored in previous studies. However, the results were uncertain 7,9,10 . As a series of disorganized metabolism, metabolic syndrome (MS) is defined including obesity, elevated BP, glucose metabolism disorders and dyslipidemia 11 .…”

Recovery from diabetes mellitus in primary aldosteronism patients after adrenalectomy

“…Third, Adler et al found that PA patients underwent adrenalectomy or mineralocorticoid receptor antagonist showed the decrease of insulin clearance, which was not due to alterations in creatinine clearance or plasma cortisol [ 6 ]. Fourth, aldosterone could increase hepatic glucose production via increased glucose-6-phosphatase and fructose-1,6-bisphosphatase and phosphoenolpyruvate carboxykinase [ 18 ]. However, the aldosterone levels of the remission or improvement group and unchanged group were not significantly different in our study.…”