Diabetes & PA

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Diabetes Care. 2007 Jul;30(7):1699-703. Epub 2007 Apr 11.

Comment in:

Diabetes Care. 2008 Jan;31(1):e2; author reply e3.

Primary aldosteronism in diabetic subjects with resistant hypertension.

Umpierrez GE, et. al

Department of Medicine, Emory University School of Medicine, Atlanta,

Georgia 30303, USA. geumpie@...

OBJECTIVE: Despite the high prevalence of hypertension in patients with type

2 diabetes, the prevalence of primary aldosteronism in this population has

not been determined. RESEARCH DESIGN AND METHODS: One hundred subjects with

type 2 diabetes and resistant hypertension, defined as blood pressure >

140/90 mmHg despite the use of > or = 3 antihypertensive agents, were

screened for primary aldosteronism. Screening was performed by measuring the

plasma aldosterone (PAC)-to-plasma renin activity (PRA) ratio. Subjects with

a PAC-to-PRA ratio > 30 ng x ml(-1) x h(-1) underwent confirmatory salt load

testing. Diagnostic criteria included 24-h urine aldosterone > or = 12

microg during the 3rd day of the oral salt load or a PAC > or = 5 ng/dl

after the 4-h intravenous saline load. RESULTS: Thirty-four subjects had a

PAC-to-PRA ratio >30 ng x ml(-1) x h(-1). Fourteen subjects (14% [95% CI

7.2-20.8]) had a confirmed diagnosis of primary aldosteronism. Ninety-three

patients were African Americans. There were no differences in age, glycemic

control, and number of antihypertensive drugs between subjects with and

without primary aldosteronism. Subjects with primary aldosteronism had lower

serum potassium (3.7 +/- 0.4 vs. 4.0 +/- 0.4 mmol/l, P = 0.012), higher PAC

(15.6 +/- 8 vs. 9.1 +/- 6 ng/dl, P = 0.0016), and higher PAC-to-PRA ratio

(98 +/- 74 vs. 21 +/- 30 x ml(-1) x h(-1), P < 0.001) than patients without

primary aldosteronism. CONCLUSIONS: Primary aldosteronism is common in

diabetic patients with resistant hypertension, with a prevalence of 14%. Our

results indicate that diabetic subjects with poorly controlled hypertension

who are taking > or = 3 antihypertensive drugs should be screened for

primary aldosteronism.

PMID: 17429062 [PubMed - indexed for MEDLINE]