Memon Saba S, Lila Anurag, Barnabas Rohit, Goroshi Manjunath, Sarathi Vijaya, Shivane Vyankatesh, Patil Virendra, Shah Nalini, Bandgar Tushar
Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India.
Department of Endocrinology, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India.
Clin Endocrinol (Oxf). 2022 Apr;96(4):539-548. doi: 10.1111/cen.14598. Epub 2021 Sep 27.
Type 2 diabetes mellitus (T2DM) and hypertension commonly coexist; however, underlying primary aldosteronism (PA) can lead to worsening of hypertension, glycemia and cardiovascular risk. We aim to screen patients with T2DM and hypertension for PA by conducting a prospective monocentric study from Western India, which included adults with T2DM and hypertension from the outpatient diabetes clinic.
Prospective study.
Patients with an aldosterone renin ratio of ≥1.6 ng/dl/µIU/ml with plasma aldosterone concentration (PAC) ≥ 10 ng/dl were considered to be positive on a screening test. A PAC ≥ 6 ng/dl on seated saline suppression test (SST) was used to confirm the diagnosis of PA.
Four hundred and eighty-six patients were included in this study. Seventy-six (15.6%, 95% confidence interval [CI]: 12.7%-19.1%) patients had a positive screening test with positive confirmatory test in 20 of the 36 (55.5%, 95% CI: 39.3%-71.7%) screen-positive patients who underwent SST. Patients with positive screening test had a higher proportion of females (65.8% vs. 50%; p = .011), frequent history of hypertensive crises (21.1% vs. 8%; p = .001), uncontrolled blood pressure (51.3% vs. 34.6%; p = .006), diagnosis of hypertension before diabetes (32.9% vs. 21.7%; p = .035) and higher systolic (137.6 ± 6.9 vs. 131.2 ± 17.8 mmHg; p = .004) and diastolic (85.3 ± 11.1 vs. 81.7 ± 10.7 mmHg; p = .007) blood pressures. Patients with positive confirmatory test had longer duration of diabetes (108 [60-162] vs. 42 [24-87] months; p = .012), hypertension (84 [42-153] vs. 36 [15-81] months; p = .038) and higher creatinine (1.16 [1.02-1.42] vs. 0.95 [0.84-1.12] mg/dl; p = .021).
PA is prevalent (at least 4.1%) in Asian Indian patients with T2DM and hypertension. Further studies are needed to assess the cost-effectiveness of routine screening.
2型糖尿病（T2DM）与高血压常并存；然而，潜在的原发性醛固酮增多症（PA）可导致高血压、血糖及心血管风险恶化。我们旨在通过一项来自印度西部的前瞻性单中心研究，对T2DM和高血压患者进行PA筛查，该研究纳入了门诊糖尿病诊所的成年T2DM和高血压患者。
前瞻性研究。
醛固酮肾素比值≥1.6 ng/dl/µIU/ml且血浆醛固酮浓度（PAC）≥10 ng/dl的患者在筛查试验中被视为阳性。坐位盐水抑制试验（SST）时PAC≥6 ng/dl用于确诊PA。
本研究纳入486例患者。76例（15.6%，95%置信区间[CI]：12.7%-19.1%）患者筛查试验阳性，36例筛查阳性患者中20例（55.5%，95%CI：39.3%-71.7%）确诊试验阳性，这些患者接受了SST。筛查试验阳性的患者中女性比例更高（65.8%对50%；p = 0.011），高血压危象病史更常见（21.1%对8%；p = 0.001），血压控制不佳（51.3%对34.6%；p = 0.006），糖尿病之前诊断为高血压的比例更高（32.9%对21.7%；p = 0.035），收缩压（137.6±6.9对131.2±17.8 mmHg；p = 0.004）和舒张压（85.3±11.1对81.7±10.7 mmHg；p = 0.007）更高。确诊试验阳性的患者糖尿病病程更长（108[60 - 162]对42[24 - 87]个月；p = 0.012），高血压病程更长（84[42 - 153]对36[15 - 81]个月；p = 0.038），肌酐水平更高（1.16[1.02 - 1.42]对0.95[0.84 - 1.12]mg/dl；p = 0.021）。
PA在亚洲印度裔T2DM和高血压患者中很常见（至少4.1%）。需要进一步研究评估常规筛查的成本效益。
