title: Risk of ischemic stroke in primary aldosteronism patients.
abstract: BACKGROUND
  High aldosterone concentrations are associated with the risk of stroke that is independent of blood pressure levels. We investigated the risk of ischemic stroke in primary aldosteronism (PA) patients.
  
  
  METHODS
  This retrospective case-control study was based on the Taiwan Primary Aldosteronism Investigation (TAIPAI) database from 2004 to 2010. The study group comprised the patients who developed ischemic stroke after the diagnosis of PA. The PA patients who did not develop stroke were matched according to age and sex as the control group. A multivariate logistic regression model was performed to determine the risk factors of ischemic stroke.
  
  
  RESULTS
  Of 339 patients diagnosed with PA, 22 patients (6.5%) developed de novo ischemic stroke. The PA patients with stroke suffered from a longer hypertensive period (11.0±6.5 vs 7.8±8.3, P=.007) and a higher prevalence of proteinuria than those who did not develop stroke (40.9% vs 12.9%, P=.002). A multivariate logistic regression model showed that PA patients with proteinuria (HR 3.58, P=.02), preexisting coronary artery disease (HR 11.12, P<.001) or left ventricular hypertrophy (HR 3.09, P=.047) were associated with an increased risk of ischemic stroke.
  
  
  CONCLUSIONS
  Proteinuria, a medical history of coronary artery disease or left ventricular hypertrophy, was associated with an increased risk of ischemic stroke in PA patients. Our results suggest that a public health initiative is necessary to enhance the follow-up of proteinuria and to manage subsequent stroke among patients with aldosteronism.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chih-Chin
authors.initials: CC
authors.lastname: Kao
authors.affiliation: Division of Nephrology, Taipei Tzu Chi General Hospital, Taiwan.
authors.forename: Che-Hsiung
authors.initials: CH
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yen-Hung
authors.initials: YH
authors.lastname: Lin
authors.affiliation: Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chin-Chen
authors.initials: CC
authors.lastname: Chang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Hsi-Hsien
authors.initials: HH
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Mai-Szu
authors.initials: MS
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: q91421028@ntu.edu.tw.
authors.forename: Vin-Cent
authors.initials: VC
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Kwan-Dun
authors.initials: KD
authors.lastname: Wu
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000150:complications*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications*; D013624:Taiwan
keywords: Ischemic stroke; Primary aldosteronism; Proteinuria