P-600: Primary aldosteronism with and without hypertensive urgency : Clinical and biochemical features:

Abstract

Primary Aldosteronism (PA)

is commonly considered in the diagnosis of a patient with hypokalemia or difficult to control hypertension. Clinical manifestations of PA are highly variable and serious hypertensive urgencies and emergencies are said to be rare. We performed a retrospective analysis of patients diagnosed with PA to identify clinical or biochemical features that would be predictive of a hypertensive emergency or urgency. Fifty-three patients who were evaluated from 1996 through 2002 at the University of Connecticut Health Center were included in this analysis. Patients included had a confirmed diagnosis of PA including a sodium suppression study and appropriate anatomic localization. They were classified as group I (resistant hypertension) and group II (hypertensive emergency based on the initial presentation or absolute blood pressure). A hypertensive emergency/urgency was defined as persistent BP > 200/100 mmHg or acute target organ damage such as pulmonary edema, cerebrovascular accident / transient ischemic attack, myocardial ischemia/infarction or acute renal failure. A comparison of the biochemical and clinical features in the two groups is shown below.

Using a linear regression model to predict Systolic BP and entering age, gender, serum aldosterone, aldosterone:renin ratio and BMI as predictor variables resulted in no significant predictors. No single biochemical or clinical feature was found to be predictive of a presentation as a hypertensive emergency/urgency and all patients with such a presentation need to be screened for primary aldosteronism. (See Table)

Clinical and Biochemical Features of 2 Presentations of PA

Parameter	Group 1	Group 2	P Value
Number	32	21
Age, years	58 ± 13	59 ± 16	.76
BMI, kg/m2	30 ± 6	31 ± 8.4	.56
Gender, F:M	15:17	8:13	.52
Potassium, mEq/L	3.6 ± 0.63	3.7 ± 0.63	.8
Creatinine, mg/dL	1.0 ± 0.3	1.2 ± 0.4	.11
Aldosterone, ng/dL	22 ± 7	26 ± 16	.3
Aldosterone (ng/dL): Plasma Renin Activity (ng/mL/h)	11–388	11–289	.66
Systolic Blood Pressure, mmHg	172 ± 28	208 ± 7	.001

aldosteronism, hypertensive emergency, secondary hypertension

© American Journal of Hypertension, Ltd. 2003