Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China.
J Clin Endocrinol Metab. 2020 Apr 1;105(4). doi: 10.1210/clinem/dgz293.
Despite a high prevalence of hypertension in diabetes and close relationship between primary aldosteronism (PA) and glucose metabolism, few study concerns the prevalence of PA in diabetes with hypertension.
This study aimed to detect the prevalence of PA in patients with new-onset type 2 diabetes (T2D) and hypertension and to explore the association between PA and diabetes.
A total of 256 outpatients with new-onset T2D and hypertension were screened for PA. Plasma aldosterone concentration (PAC), plasma renin activity (PRA) were measured. Patients with an aldosterone renin activity ratio (ARR) ≥ 30 ng/dL/ng/mL/h and PAC ≥ 15 ng/dL underwent confirmatory captopril challenge test (CCT) for PA. The diagnostic criteria for PA were, after CCT, (1) PAC decreased < 30%, (2) ARR maintained ≥ 30 ng/dL/ng/mL/h, and (3) PAC was ≥ 11 ng/dL.
Of 256 consecutive patients, 99 (39%) were positive for the screening test, and 49 (19%) were diagnosed with PA. Compared with those in groups A (screening test -) and B (screening test +, CCT -), patients in group C (diagnosed with PA) had a higher percentage of systolic blood pressure of ≥ 160 mmHg, less family history of hypertension, and lower serum potassium. Patients in group B and C had higher PAC and ARR levels, but lower PRA than those in group A. Homeostatic model assessment for insulin resistance (HOMA-IR) was positively associated with PAC level among the diabetic patients.
The prevalence of PA in new-onset T2D patients with hypertension is at least 19%. Higher aldosterone may be related with insulin resistance in patients with diabetes.
尽管糖尿病患者中高血压的患病率很高，且原发性醛固酮增多症（PA）与葡萄糖代谢密切相关，但很少有研究关注高血压合并糖尿病患者中 PA 的患病率。
本研究旨在检测新诊断的 2 型糖尿病（T2D）合并高血压患者中 PA 的患病率，并探讨 PA 与糖尿病之间的关系。
对 256 例新诊断的 T2D 合并高血压患者进行 PA 筛查。测量血浆醛固酮浓度（PAC）、血浆肾素活性（PRA）。ARR≥30ng/dL/ng/mL/h且 PAC≥15ng/dL 的患者进行醛固酮肾素活性比（ARR）筛查试验阳性的确诊性卡托普利挑战试验（CCT）以确诊 PA。PA 的诊断标准为：（1）CCT 后 PAC 下降<30%；（2）ARR 维持≥30ng/dL/ng/mL/h；（3）PAC≥11ng/dL。
在 256 例连续患者中，99 例（39%）筛查试验阳性，49 例（19%）诊断为 PA。与筛查试验阴性组（A 组）和筛查试验阳性、CCT 阴性组（B 组）相比，诊断为 PA 组（C 组）的收缩压≥160mmHg 的比例更高，高血压家族史更少，血清钾水平更低。B 组和 C 组患者的 PAC 和 ARR 水平较高，但 PRA 水平低于 A 组。糖尿病患者中稳态模型评估的胰岛素抵抗指数（HOMA-IR）与 PAC 水平呈正相关。
新诊断的 T2D 合并高血压患者中 PA 的患病率至少为 19%。较高的醛固酮水平可能与糖尿病患者的胰岛素抵抗有关。
