Prevalence of primary aldosteronism in type 2 diabetes mellitus and hypertension: A prospective study from Western India

Memon, Saba Samad; Lila, Anurag; Barnabas, Rohit; Goroshi, Manjunath; Sarathi, Vijaya; Shivane, Vyankatesh; Patil, Virendra; Shah, Nalini; Bandgar, Tushar

doi:10.1111/cen.14598

Cited by 4 publications

(10 citation statements)

References 33 publications

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“…The results of this study show a prevalence of PA in patients with HDM-2 that is much higher (34.3%) than ever reported, which has ranged from 0.0 to 22.4% [ 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. In addition, an exaggerated aldosterone response to stress through ACTH administration was observed in another 10.3% of the tested HDM-2 non-PA patients.…”

Section: Discussionmentioning

confidence: 49%

“…In the first published study in which only the basal plasma aldosterone concentration/plasma renin activity (PAC/PRA) ratio (>70) was used for the diagnosis of PA, no PA cases were detected among 61 HDM-2 patients [ 18 ]. In other published studies, the PA prevalence in HDM-2 ranged between 4.1% and 22.4% [ 19 , 20 , 21 , 22 , 23 , 24 ]. In these studies, the diagnosis of PA was based on the standard methodology initially using as a screening test the basal PAC/PRA ratio and as confirmatory test mainly the 2 lt saline infusion.…”

Section: Discussionmentioning

confidence: 95%

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High Prevalence of Primary Aldosteronism in Patients with Type 2 Diabetes Mellitus and Hypertension

et al. 2022

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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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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 95%

High Prevalence of Primary Aldosteronism in Patients with Type 2 Diabetes Mellitus and Hypertension

et al. 2022

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“…Prevalence studies have reported, 50-55 years as the average age of PH patients at diagnosis[ 15 , 18 ]. The mean age of individuals at presentation was similar in the current study across three groups.…”

Section: Discussionmentioning

confidence: 99%

“…Our PH subjects with T2DM had a mean diabetes duration of 6.0 ± 4.7 years compared to mean duration of hypertension of 14.8 ± 7.4 years. A recent study in diabetes subjects reported hypertension predates DM diagnosis in PH patients compared to EH, whereas diabetes diagnosis antedate hypertension detection[ 18 ]. A meta-analysis reported, 15.2% prevalence of new onset T2DM in PH patients, corroborating PH pathophysiology leading to dysglycemia and T2DM[ 15 ].…”

Section: Discussionmentioning

confidence: 99%

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

Sanyal,

Mukhopadhyay,

Ghosh

2024

World J Clin Cases

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BACKGROUND Primary hyperaldosteronism (PH) is considered to contribute to increased risk of developing type 2 diabetes mellitus (T2DM) and prediabetes. Both PH and DM are associated with increased risk for hypertension, cardiovascular diseases, and chronic kidney diseases. However, data on prevalence of T2DM and prediabetes in PH, and impact of T2DM and prediabetes on presentation and cardio renal complications in PH at presentation is sparse. AIM To determine the prevalence of T2DM and prediabetes in PH at diagnosis and impact on presentation and complications of PH. METHODS A retrospective cohort study was conducted in tertiary care settings in individuals with confirmed diagnosis of PH at presentation. Demographic variables, clinical presentations, duration and degree of hypertension, complications, laboratory parameters including sodium, potassium levels, plasma aldosterone concentration (PAC), plasma renin activity (PRA), and aldosterone to renin ratio (ARR) and cardio-renal parameters were collected. Comparison was done between three groups: PH with no DM (Group A) or with pre-diabetes (Group B) or with T2DM (Group C). P < 0.05 was statistically significant. RESULTS Among 78 individuals with confirmed PH, 62% had pre-diabetes or diabetes; with 37% having DM. Mean duration of T2DM was 5.97 ± 4.7 years. The mean levels of glycaemic parameters among the group A vs B vs C individuals were fasting plasma glucose (mg/dL): 87.9 ± 6.5, 105.4 ± 9.02, 130.6 ± 21.1; post prandial plasma glucose (mg/dL): 122.7 ± 9.8, 154.9 ± 14, 196.7 ± 38.0; glycated haemoglobin (%) (5.3 ± 0.2, 5.9 ± 0.2, 7.5 ± 0.6, P < 0.05 ), respectively. There was no significant difference in the biochemical parameters (PAC, PRA, ARR, sodium, potassium levels), presentation and complications between the groups. Cardio renal parameters or degree and duration of hypertension were comparable between the groups. CONCLUSION Significant prevalence of T2DM and prediabetes in PH at diagnosis does not impact its presentation or complications. Early screening for undetected PH in T2DM and prediabetes subjects with hypertension may prevent complications.

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“…[91] Current guidelines do not yet endorse screening for PA in patients with atrial fibrillation. [12,38] Stroke, [92,93] diabetes mellitus, [94,95] and obesity [96] are other disorders associated with overt PA. Further epidemiologic and mechanistic studies are needed to understand these associations prior to expanding PA screening recommendations.…”

Section: Other Conditions Associated With Pamentioning

confidence: 99%

Primary Aldosteronism Prevalence – An Unfolding Story

Charoensri

Turcu

2023

Exp Clin Endocrinol Diabetes

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Primary aldosteronism (PA) is characterized by dysregulated, renin-independent aldosterone excess. Long perceived as rare, PA has emerged as one of the most common causes of secondary hypertension. Failure to recognize and treat PA results in cardiovascular and renal complications, through processes mediated by both direct target-tissue insults, and indirectly, by hypertension. PA spans a continuum of dysregulated aldosterone secretion, which is typically recognized in late stages, after treatment-resistant hypertension and cardiovascular and/or renal complications develop. Determining the precise disease burden remains challenging, due to heterogeneity in testing, arbitrary thresholds, and populations studied. In this review, we summarize the reports on PA prevalence among the general population and in specific high-risk subgroups, highlighting the impact of rigid versus permissive criteria on PA prevalence perception.

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Prevalence of primary aldosteronism in type 2 diabetes mellitus and hypertension: A prospective study from Western India

Cited by 4 publications

References 33 publications

High Prevalence of Primary Aldosteronism in Patients with Type 2 Diabetes Mellitus and Hypertension

High Prevalence of Primary Aldosteronism in Patients with Type 2 Diabetes Mellitus and Hypertension

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

Primary Aldosteronism Prevalence – An Unfolding Story

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