Autonomous aldosterone secretion as a significant cause of arterial hypertension: the effectiveness of targeted therapy

Labrini Papanastasiou; Theodora Pappa; Stelios Fountoulakis; Panagiotis Tsounas; Athina Markou; Vaios Tsiavos; Marina Anastasakou; Chrisanthi Marakaki; Dimosthenis Malliopoulos; Theodora Kounadi; George Piaditis

doi:10.1530/endoabs.32.P46

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Endocrine Abstracts (2013) 32 P46 | DOI: 10.1530/endoabs.32.P46

ECE2013 Poster Presentations Adrenal cortex (64 abstracts)

Autonomous aldosterone secretion as a significant cause of arterial hypertension: the effectiveness of targeted therapy

Labrini Papanastasiou , Theodora Pappa , Stelios Fountoulakis , Panagiotis Tsounas , Athina Markou , Vaios Tsiavos , Marina Anastasakou , Chrisanthi Marakaki , Dimosthenis Malliopoulos , Theodora Kounadi & George Piaditis

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Department of Endocrinology and Diabetes Center, ‘G Gennimatas’ General Hospital, Athens, Greece.

Introduction: The prevalence of autonomous aldosterone secretion (AAS) in hypertensive subjects varies due to the use of various suppression tests and cut-off values. Our aim was to evaluate the prevalence of AAS in hypertensive subjects and test the anti-hypertensive effect of targeted treatment of the renin angiotensin II aldosterone system (RAAS) in AAS subjects.

Description of methods/design: We investigated 336 hypertensive subjects with and without adrenal adenoma and 83 age- and sex- matched normotensive subjects, with normal adrenal glands on computerized tomography. Serum aldosterone (ALD) and active renin levels (REN) and the aldosterone/active renin (ALD/REN) ratio were measured before and after a modified fludrocortisone suppression test (FDST - fludrocortisone suppression test after dexamethasone administration). Normal cut-offs were obtained from the controls (ALD levels post-FDST 82 pmol/l and ALD/REN post-FDST 25 pmol/mIU per l).

Results: By applying the combination of serum ALD post-FDST levels and the ALD/REN post- FDST ratio, the prevalence of AAS in hypertensive subjects was 31.3%. We found positive correlations between systolic (SBP) and diastolic (DBP) blood pressure and serum ALD and the ALD/REN ratio before and post-FDST (P <0.001). After dividing in quintiles the ALD post-FDST levels of hypertensive subjects, the association of ALD post-FDST levels with SBP and DBP became statistically significant in the 4th (ALD levels >101 pmol/l) and 5th quintile (ALD levels >155 pmol/l) respectively. An inverse association between serum K⁺ and ALD post- FDST levels was shown, that became significant for K⁺ levels over 4 mEq/l.

Treatment targeting the RAAS with mineralocorticoid receptor antagonists or angiotensin II receptor blockers in 68 AAS subjects resulted in a marked decrease of SBP and DBP values (P<0.001).

Conclusions: Using this methodology for detection of AAS an increased prevalence of AAS was found in hypertensive subjects. Targeted treatment of AAS subjects adequately controlled their blood pressure.