Endocrine Abstracts

Introduction: Hypertension remains a significant co-morbidity in the population with diabetes, with a prevalence of 20–60%. In type 2 diabetes, hypertension is often present as part of the metabolic syndrome of insulin resistance. In type 1 diabetes, hypertension may reflect the onset of diabetic nephropathy.

Aims: To investigate the prevalence of, and to stratify, hypertension in our diabetes clinic population. To investigate prevalence of risk factors meriting further investigation for primary aldosteronism in this target population.

Standards: The Endocrine Society Guidelines (2008) on screening for primary aldosteronism and the Joint National Commission 6th Guideline (1997) on stratifying hypertension.

Exclusion criteria: Presence of diabetic nephropathy.

Method: Retrospective data collection on 119 patients who attended the diabetes clinic in October 2008. Of 19% were excluded: 16 had diabetic nephropathy; three had incomplete documentation.

Results: Hundred patients were included (42 males and 58 females); type 1 diabetes – 24%, type 2 diabetes – 71%, secondary diabetes – 4% and other – 1%. The mean patient age was 56.8 years (range 29–79). Using the Joint National Committee stages of hypertension, 45% were not hypertensive, 30% had stage 1, 16% stage 2 and 9% stage 3 hypertension. Four patients had drug resistant hypertension: blood pressure more than 140 mmHg systolic and 90 mmHg diastolic despite three antihypertensive medications. Twenty one percent were on no anti-hypertensive, 33% on one, 22% on two, 15% on three, 7% on four and 2% on five. Only one patient was hypokalaemic (potassium<3.5 mmol/l) and hypertensive. Twenty five percent of patients fulfilled criteria for screening for primary aldosteronism, all by virtue of their stage 2 (16%) or stage 3 (9%) hypertension. None of these patients had plasma renin-aldosterone ratios measured.

Conclusions: Hypertension remains a significant and difficult to treat problem in the diabetic population. Twenty five percent of patients merit further screening to investigate for possible primary aldosteronism.