title: Type 2 diabetic patients with resistant hypertension should be screened for primary aldosteronism.
abstract: BP control in diabetic patients is often poor. The contribution of secondary hypertension due to undiagnosed PA in hypertensive type 2 diabetic patients is not well studied. We prospectively screened 100 consecutive Asian type 2 diabetic patients with difficult-to-control or resistant hypertension for PA. PAC (pmol/L) to PRA (ng/mL/h) ratio was measured; those with PAC-to-PRA ratio >550 (corresponding PAC >415) underwent intravenous 0.9% SLT. Patients with PAC >/=140 following SLT had CT adrenals and bilateral AVS. Thirteen patients (13%) were confirmed to have PA, and all had resistant hypertension. Eight had a surgically correctable form of PA. Patients with PA had higher mean (SD) systolic [159.0 (10.6) vs. 146.0 (10.7) mmHg, p=0.001] and diastolic BP [94.6 (6.0) vs. 87.6 (5.9) mmHg, p=0.001], lower serum potassium [3.5 (0.6) vs. 4.3 (0.5) mmol/L, p=0.001], and higher PAC [679.3 (291.0) vs. 239.5 (169.4) pmol/L, p=0.001]. Identification and institution of definitive treatment for PA resulted in better BP control and in a reduction in the use of antihypertensive medications. Our findings demonstrate a high prevalence of PA in type 2 diabetic patients with resistant hypertension. Systematic screening for PA in this select group is recommended, as targeted treatment improves BP control.
authors.affiliation: Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore. jjmukh@nuh.com.sg
authors.forename: J J
authors.initials: JJ
authors.lastname: Mukherjee
authors.forename: C M
authors.initials: CM
authors.lastname: Khoo
authors.forename: A C
authors.initials: AC
authors.lastname: Thai
authors.forename: S B
authors.initials: SB
authors.lastname: Chionh
authors.forename: Lim
authors.initials: L
authors.lastname: Pin
authors.forename: K O
authors.initials: KO
authors.lastname: Lee
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D044466:Asian People / Q000706:statistics & numerical data; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000208:ethnology*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000208:ethnology*; D006977:Hypertension, Renal / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents