High Prevalence of Primary Aldosteronism in Patients with Type 2 Diabetes Mellitus and Hypertension
Ernestini Tyfoxylou,
Nick Voulgaris,
Chris Gravvanis,
Sophia Vlachou,
Athina Markou,
Labrini Papanastasiou,
Nikolaos Tentolouris,
Eva Kassi,
Gregory Kaltsas,
George P. Chrousos,
George P. Piaditis
Affiliations
Ernestini Tyfoxylou
Department of Endocrinology, Diabetes Center, “G. Gennimatas” General Hospital of Athens, 11527 Athens, Greece
Nick Voulgaris
Department of Endocrinology, Diabetes Center, “G. Gennimatas” General Hospital of Athens, 11527 Athens, Greece
Chris Gravvanis
Department of Endocrinology, Diabetes Center, “G. Gennimatas” General Hospital of Athens, 11527 Athens, Greece
Sophia Vlachou
Department of Endocrinology, Diabetes Center, “G. Gennimatas” General Hospital of Athens, 11527 Athens, Greece
Athina Markou
Department of Endocrinology, Diabetes Center, “G. Gennimatas” General Hospital of Athens, 11527 Athens, Greece
Labrini Papanastasiou
Department of Endocrinology, Diabetes Center, “G. Gennimatas” General Hospital of Athens, 11527 Athens, Greece
Nikolaos Tentolouris
Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
Eva Kassi
Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece
Gregory Kaltsas
Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
George P. Chrousos
University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, 15772 Athens, Greece
George P. Piaditis
Department of Endocrinology, Diabetes Center, “G. Gennimatas” General Hospital of Athens, 11527 Athens, Greece
Primary aldosteronism (PA) is the most common cause of endocrine hypertension. The prevalence of hypertension is higher in patients with diabetes mellitus-2 (DM-2). Following the limited existing data, we prospectively investigated the prevalence of aldosterone excess either as autonomous secretion (PA) or as a hyper-response to stress in hypertensive patients with DM-2 (HDM-2). A total of 137 HDM-2 patients and 61 non-diabetics with essential hypertension who served as controls (EH-C) underwent a combined, overnight diagnostic test, the Dexamethasone–captopril–valsartan test (DCVT) used for the diagnosis of PA and an ultralow dose (0.3 μg) ACTH stimulation test to identify an exaggerated aldosterone response to ACTH stimulation. Twenty-three normotensive individuals served as controls (NC) to define the normal response of aldosterone (ALD) and aldosterone-to-renin ratio (ARR) to the ultralow dose ACTH test. Using post-DCVTALD and ARR from the EH-C, and post-ACTH peak ALD and ARR from the NC, 47 (34.3%) HDM-2 patients were found to have PA, whereas 6 (10.4%) HDM-2 patients without PA (DCVT-negative) exhibited an exaggerated aldosterone response to stress—a prevalence much higher than ever reported. Treatment with mineralocorticoid receptor antagonists (MRAs) induced a significant and permanent reduction of BP in all HDM-2 patients. Early diagnosis and targeted treatment of PA is crucial to prevent any aggravating effect on chronic diabetic complications.
