Abstract 131: Screening test results for detecting primary aldosteronism in Type2 diabetes mellitus patients with resistant hypertension attending to outpatient clinic

Objective: Primary aldosteronism is the most common form of secondary hypertension. Despite the high prevalence of hypertension among diabetic patients, the prevalence of primary aldosteronism is not known because screening of primary aldosteronism is seldom performed. Identification of primary aldosteronism in Diabetic population with refractory hypertension gives a chance to prevent the morbidity and fatality associated with primary aldosteronism. We aim to screen patients for primary aldosteronism by conducting a prospective study which included adults with Type2 DM and resistant hypertension from the outpatient diabetic clinic. Patients and Measurements: Total 86 consecutive subjects with Type2 DM and Resistant hypertension (defined as BP greater than 140/90mm Hg in spite of the concurrent use of 3 anti hypertensive medications of different classes at pharmacologically effective doses or controlled BP <140/90mmHg on four or more antihypertensive agents) were screened for Primary aldosteronism. Patients with a plasma Aldosterone concentration to Direct renin ratio (PAC/DRC) of 32.4 ng/dl/mIU/ml along with Plasma Aldosterone Concentration (PAC) 3 10 ng/dl were considered to be positive on a screening test. Results: 1 8 subjects out of 86 subjects screened, (20.9% [95% CI 13.2-31.3%]) tested positive for Primary Aldosteronism. There were no differences in age, sex, serum potassium, duration of hypertension, duration of diabetes and number of antihypertensive drugs between subjects with and without primary aldosteronism. Subjects with primary aldosteronism had higher Plasma Aldosterone Concentration values (PAC) (20.53 ± 8.28 vs. 11.42 ± 7.35 ng/dl, P < 0.001) lower Direct Renin Concentration values (DRC) (3.88 ± 2.41 vs. 62.54 ± 112.88 mIU/ml, P < 0.001) and higher Plasma Aldosterone Concentration to Direct Renin Ratio (PAC/DRC) (6.43 ± 2.71 vs. 1.16 ± 1.89 ng/dl/mIU/ml, P < 0.001) than patients without Primary aldosteronism. Conclusion: Primary aldosteronism is prevalent (maximum 20.9%) in Indian patients with Type2 DM and Resistant hypertension. Systematic screening for Primary aldosteronism in this select group is recommended, as targeted treatment improves morbidity and mortality associated with primary aldosteronism.