Female patients with primary aldosteronism are diagnosed earlier and have a better outcome
A. Pallauf, E. Fischer, S. Endres, M. Bidlingmaier, F. Beuschlein & M. Reincke
Introduction: Primary aldosteronism (PA) is the most frequent curable form of hypertension. Hypokalemia is a late symptom of PA. Consequently, PA often is not diagnosed for many years. Our aim was to identify clinical and laboratory parameters in a large cohort of PA patients obtained during their first assessment.
Methods: 96 consecutive patients prospectively studied since 2008 at the German Conns Registry Center in Munich were eligible for this study. Diagnosis of PA was established using the criteria recommended by the Endocrine Society. Clinical data were analysed according to gender. Adrenal vein sampling revealed that 62.5% patients had a unilateral adenoma and 31.1% bilateral hyperplasia.
Results: Mean age at diagnosis was 52 years. Female patients (n=34, 35.4%) were diagnosed 10 years earlier than males (44.8 vs. 54.8 years). The time from initial recognition of hypertension to PA diagnosis was 12.8 years, 9.8 in females vs. 14.5 years in males. 33% of the females vs. 16.4% of the males presented with pre-hypertension (120-139/80-89 mmHg).
The prevalence of coronary heart disease was 5.2%, thrombosis 3.1%, stroke 2.1% and peripheral arterial occlusive disease 1%. Combined cardiovascular morbidity was similar in females and males (11.8 vs. 11.3%); women, however, had a higher risk of thrombosis (6% vs. 1.6%).
Specific treatment (adrenalectomy or mineralocorticoid antagonist treatment) reduced mean 24h-blood pressure from 150/94 to 134/83 mmHg (P<0.01).
Graded according to the WHO classification, 60% of all patients became normotensive, 67% of the operated patients still requiring antihypertensive medication (50% in females, 73% in males).
Conclusion: Women with PA have a high risk of cardiovascular diseases although they are diagnosed 10 years earlier than men and hypertension is often not as obvious. They have a 50% chance of reaching normotension without antihypertensive medication.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This work was supported, however funding details unavailable.