ECE2015 Guided Posters Adrenal (2) (8 abstracts)
1Hospital Clinico San Carlos, Madrid, Spain; 2Hospital Clinico de Valladolid, Valladolid, Spain; 3Beaumont Hospital, Dublin, Ireland.
Introduction: Some authors consider aldosteronism to be a spectrum, ranging from aldosterone-associated (or low-renin) hypertension (AAH) to primary hyperaldosteronism (PHA) due to bilateral adrenal hyperplasia. Thus, blood pressure (BP) response to mineralocorticoid-receptor blockade (MRB) could be similar.
Methods: Retrospective analysis of 60 patients. Screening per Endocrine Society guidelines, positive screening: aldosterone (pg/ml) to direct-renin (pg/ml) (ARR) ≥25. 25-mg Captopril test (CAP) on doxazosine and/or long-acting verapamil, positive for PHA if aldosterone ≥130 pg/ml or ARR ≥50, 1 or 2 h post-captopril. Patients negative for PHA with basal CAP ARR ≥50 or low renin levels were diagnosed with AAH. MRB (50100 mg spironolactone or 200300 mg eplerenone) as sole BP medication. BP (mmHg). MannWhitney U, Students t, and Wilcoxon, χ2 tests. SPSS 15.
Results: Baseline characteristics HAP vs AAH: 28/60 vs 32/60 patients, 67.9% vs 75% women, mean age 55.4 (S.D.: 2.7) vs 53.9 (S.D.: 9.9). Number BP-lowering drugs: 2 (IQR: 12) vs 1 (IQR: 12). Resistant hypertension (RH): 6/28 (21.4%) vs 2/32 (6.3%). Major CV events and/or renal failure: 8/28 (28.6%) vs 5/32 (15.6%), P=0.06. Hypokalemia: 5/28 (17.8%) vs 0/32 (0%), P=0.003. Serum potassium (mmol/l) (SK): 4.0 mmol/l (S.D.: 0.6) vs 4.2 (S.D.: 0.5) (n: 3.55.5), serum creatinine (mg/dl) (SC): 1.0 (S.D.: 0.5) vs 0.89 (S.D.: 0.3), office systolic BP (SBP): 154 (S.D.: 22.6) vs 151 (S.D.: 16.6), office diastolic BP (DBP): 90 (S.D.: 14.4) vs 90 (S.D.: 12.1). Response to 2 weeks of MRB: SBP 128 (S.D.: 15.7) vs 123 (S.D.: 11.8), DBP: 77 (S.D.: 10.7) vs 75 (S.D.: 9.1). SK: 4.6 (S.D.: 0.5) vs 4.7 (S.D.: 0.5). SC: 1.14 (S.D.: 0.7) vs 1.00 (S.D.: 0.4). The descent in both SBP and DBP was significant in PHA (both P<0.001) as in AAH (both P<0.001). No significant differences were found in SBP (P=0.569) nor DBP (P=0.389) reductions following MRB in PHA vs AAH.
Conclusion: The CAP can identify both patients with PHA and AAH. Both groups present a similar, dramatic and rapid BP response to high-dose MRB, suggesting that AAH patients should be identified, and the same protocol for medical therapy used in PHA and AAH. Furthermore, our results support the hypothesis that aldosterone-induced hypertension is a continuum.