Zhixin Xu1, Jun Yang2, Jinbo Hu1, Ying Song1, Wenwen He1, Ting Luo1, Qingfeng Cheng1, Linqiang Ma1, Rong Luo1, Peter J Fuller3, Jun Cai4, Qifu Li5, Shumin Yang6. 1. Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. 2. Department of Medicine, Monash University, Clayton, Victoria, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia. 3. Department of Medicine, Monash University, Clayton, Victoria, Australia. 4. Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. 5. Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Electronic address: liqifu@yeah.net. 6. Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Electronic address: 443068494@qq.com.
Abstract
BACKGROUND: A total of 44.7% adults in China have hypertension, but the prevalence of primary aldosteronism (PA) in Chinese hypertensive patients is unknown. OBJECTIVES: This study prospectively investigated the prevalence, characteristics, and outcomes of PA in newly diagnosed hypertensive patients. METHODS: In a large community health center, consecutive hypertensive patients with an aldosterone-renin ratio >20 ng/mIU and plasma aldosterone concentration >10 ng/dl underwent captopril challenge test and/or saline infusion test for confirmation of PA. Adrenal computed tomography scan and adrenal vein sampling were used for subtyping. PA patients treated with surgery or medication were followed up for 1 year, and outcomes after treatment were evaluated. RESULTS: In total, 1,020 newly diagnosed hypertensive patients were screened over 16 months, of whom 40 were diagnosed with PA, 948 with non-PA, 32 with probable PA, resulting in a prevalence of more than 4.0%. Compared with non-PA, PA patients more frequently displayed microalbuminuria (p = 0.031), but the incidence of cardiovascular events was not different (p = 0.927). For surgically treated patients (n = 7), a complete biochemical success rate was 100% and a complete clinical success rate was 85.7%. For medically treated patients (n = 29), the proportion with optimal blood pressure control was 79%, and among them, 91% (21 of 23) only needed 1 antihypertensive drug: the mineralocorticoid receptor antagonist. CONCLUSIONS: The prevalence of PA in patients with newly diagnosed hypertension in China was at least 4%. PA screening in newly diagnosed hypertensive patients leads to good clinical outcomes. (Primary Aldosteronism In Hypertensive Patients in China [PA-China]; NCT03155139).
BACKGROUND: A total of 44.7% adults in China have hypertension, but the prevalence of primary aldosteronism (PA) in Chinese hypertensivepatients is unknown. OBJECTIVES: This study prospectively investigated the prevalence, characteristics, and outcomes of PA in newly diagnosed hypertensivepatients. METHODS: In a large community health center, consecutive hypertensivepatients with an aldosterone-renin ratio >20 ng/mIU and plasma aldosterone concentration >10 ng/dl underwent captopril challenge test and/or saline infusion test for confirmation of PA. Adrenal computed tomography scan and adrenal vein sampling were used for subtyping. PA patients treated with surgery or medication were followed up for 1 year, and outcomes after treatment were evaluated. RESULTS: In total, 1,020 newly diagnosed hypertensivepatients were screened over 16 months, of whom 40 were diagnosed with PA, 948 with non-PA, 32 with probable PA, resulting in a prevalence of more than 4.0%. Compared with non-PA, PA patients more frequently displayed microalbuminuria (p = 0.031), but the incidence of cardiovascular events was not different (p = 0.927). For surgically treated patients (n = 7), a complete biochemical success rate was 100% and a complete clinical success rate was 85.7%. For medically treated patients (n = 29), the proportion with optimal blood pressure control was 79%, and among them, 91% (21 of 23) only needed 1 antihypertensive drug: the mineralocorticoid receptor antagonist. CONCLUSIONS: The prevalence of PA in patients with newly diagnosed hypertension in China was at least 4%. PA screening in newly diagnosed hypertensivepatients leads to good clinical outcomes. (Primary Aldosteronism In HypertensivePatients in China [PA-China]; NCT03155139).
Authors: Renata Libianto; Jinbo Hu; Min R Chee; Jesse Hoo; Yin Y Lim; Jimmy Shen; Qifu Li; Morag J Young; Peter J Fuller; Jun Yang Journal: J Endocr Soc Date: 2020-10-16