Endocrine Abstracts

Introduction: Control of hypertension (HT) is essential to reduce cardiovascular events in diabetic patients (DPts). However, studies indicate that only 50% of DPts with treated hypertension present adequate blood pressure (BP) control. Yet Endocrine-Society-Guideline (ESG) screening for primary hyperaldosteronism (PHA) is rarely applied. Furthermore, in patients with essential hypertension (EH), longer-acting hypertension medication (HM) improves 24-hour BP when compared to related agents with a short half-life (SHL). We evaluated the application of the ESG for PHA in DPts, and the result of therapy using only HM with an extended-half-life (EHL) in EH-DPts.

Material and methods: A retrospective observational study. Over 2 years (2013–2014), in an Endocrine-outpatient clinic, 162 consecutive patients, 73/162 DPts, were screened for PHA in application of ESG. Aldosterone/renin ration(ARR) was determined, screening considered positive with ARR≥25, aldosterone and renin by RIA in pg/ml. PHA diagnosis: aldosteronemia≥130 and/or ARR≥50 2 hours post-25 mg captopril. Low-renin hypertension (LRH): patients not fulfilling these criteria maintaining renin levels≤5.5. throughout the test, and/or basal ARR≥50. These patients were changed to mineralocorticoid-receptor blockers (MRB). In the remaining patients, EH was diagnosed. If BP control was inadequate, and EH patients were receiving any SHL HM (<16 hours), a switch was made to EHL: Irbesartan/telmisartan, when needed amlodipine, with clorthalidone as 3rd potential agent. At least one medication was administered in the evening. Office BP was compared in DPts immediately before and 2–6 weeks post-HM modification. Results in mean (standard deviation). Student’s T-test.

Results: In DPts. Age: 70.3 (12.5), age at HT diagnosis: 55.7 (13.3). Women: 53.4%. PHA: 8/73 (11%). LRH: 6/73 (8.2%), EH: 59/73 (80.8%). Main Indications for screening: moderate HT in 46.6%, severe HT in 40%. Following MRB, aldosteronism patients (PHA+LRH) presented a systolic BP (SBP) decrease from 146 mmHg (18.7) to 124 (7.74) (P=0.019), diastolic BP(DBP) from 83.6 mmHg (11.94) to 73 (9.14) (P=0.01). EH: 6 lost-to-follow-up. In the 37 EH with SHL, following LAM switch, SBP dropped from 148mmHg (22.6) to 126 (12) (P=0.001); DBP from 84 mmHg (15.3) to 71 (8.3) (P=0.01). The switch was accompanied by a reduction in the number of HM: from 2.21 (0.75) to 1.71 (0.6) (P=0.007).

Conclusions: 11% of our diabetic patients with hypertension and indication for screening presented Primary Hyperaldosteronism. Given its high morbimortality, the Endocrine-Society Hyperaldosteronism Guideline should be applied in DPts. In DPts with Essential Hypertension, long-acting medication could permit improved BP control.