title: Primary aldosteronism in diabetic subjects with resistant hypertension.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30303, USA. geumpie@emory.edu
authors.forename: Guillermo E
authors.initials: GE
authors.lastname: Umpierrez
authors.forename: Paul
authors.initials: P
authors.lastname: Cantey
authors.forename: Dawn
authors.initials: D
authors.lastname: Smiley
authors.forename: Andres
authors.initials: A
authors.lastname: Palacio
authors.forename: Diana
authors.initials: D
authors.lastname: Temponi
authors.forename: Karen
authors.initials: K
authors.lastname: Luster
authors.forename: Arlene
authors.initials: A
authors.lastname: Chapman
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000453:epidemiology*; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology*; D008875:Middle Aged; D015995:Prevalence
chemical_list: D000959:Antihypertensive Agents