Case Detection with Aldosterone to Renin Ratio and Plasma Aldosterone Concentration Identifies Primary Aldosteronism at Higher Risk for Cardiovascular and Renal Complications

Presentation Number: SUN 518
Date of Presentation: April 2nd, 2017

Hisashi Fukuda*1, Takuyuki Katabami2, Hiroshi Ito3, Isao Kurihara4, Yoshiyu Takeda5, Takamasa Ichijo6, Mika Tsuiki7, Hironobu Umakoshi7, Yasushi Tanaka8, Mitsuhide Naruse7 and Jpas Group9
1St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan, 2St Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama-shi Kanagawa, Japan, 3Keio University School of Medicine, 4School of Medicine, Keio University, Tokyo, Japan, 5Kanazawa University, Kanazawa, Japan, 6Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan, 7National Hospital Organization Kyoto Medical Center, Kyoto, Japan, 8St. Marianna University School of Medicine, Japan, 9National Hospital Organization Kyoto Medical Center

Abstract

Objectives: The consensus statement on the clinical practice of primary aldosteronism (PA) in Japan recommends case detection by aldosterone to renin ratio (ARR) >20 combined with a plasma aldosterone concentration (PAC) >12 ng/dL. However, the clinical significance of the combination remains to be elucidated. The aim of the present study was to compare various clinical characteristics between patients with PAC ≥12 ng/dL and those with PAC <12 ng/dL. Subjects and Methods: We organized a Japan PA study (JPAS) group with 33collaborating centers. Patients diagnosed as having PA based on a positive case detection with ARR>20 together with at least one positive confirmatory test between Jan 2006 and Dec 2015 were enrolled (N=2,172). Subtype diagnosis was made by adrenal venous sampling.PA patients were classified into an H group (PAC ≧12 ng/dL) and an L group (PAC <12 ng/dL).Clinical findings including age, blood pressure (BP), serum K, presence of adrenal nodule on computed tomography, PA subtype, choice of treatment, and prevalence of cardiovascular events (CVEs) and renal dysfunction were compared between the 2 groups. Results: Number of PA patients was 1,637 in the H group and 474 in the L group, respectively. At the time of diagnosis, age was younger (52.5±11.3 vs. 55.6±10.3 yrs., p<0.001), diastolic BP (86.8±12.7 vs. 85.1±13.1 mmHg, p=0.011), rate of having adrenal nodule (70.5% vs. 61.6%, p<0.001), prevalence of unilateral subtype (47.4% vs. 20.4%, p<0.001) and indication of adrenal surgery (23.8% vs. 8.7%, p<0.001) was significantly higher in the H group than in the L group, while serum K concentration was lower in the H group (3.7±2.5 vs. 3.9±0.4 mEq/L, p=0.005). The duration of hypertension (9.2±9.0 vs. 6.9±7.8 years, p<0.001) was longer and prevalence of CVEs (12.0 vs. 5.8%, p<0.001) and positive rate of urine protein (14.0% vs. 4.9%, p<0.001) were higher in the H group than the L group. In addition, the incidence of CVEs during the follow-up period (median observation period: 12.1 months in the H group, 11.5 months in the L group) was higher in the H group than in L group (5.9 vs. 2.8%, p=0.043). Conclusion: Case detection of PA by a combination of ARR >200 and PAC ≧12 ng/mL could be useful in identifying those with higher prevalence of cardiovascular and renal complications and/or those who may develop CVEs.

Supported by grants-in-aid from the Practical Research Project for Rare/Intractable Disease from Japan Agency for Medical Research and development, AMED, Japan: 15Aek0109122

 

Disclosure: TK: Protocol review committee, ONO-Pharma, Investigator, ONO-Pharma. MT: Investigator, ONO-Pharma. MN: Coordinating Investigator, ONO-Pharma, Investigator, ONO-Pharma. Nothing to Disclose: HF, HI, IK, YT, TI, HU, YT, JG