Characteristics and treatment of subclinical primary aldosteronism

LIU Xiao-li; ZHANG He-xuan; HE Hong-bo; ZHAO Zhi-gang; YAN Zhen-cheng; ZHU Zhi-ming; YANG Gang-yi

doi:10.19538/j.nk2024110111

Abstract：Objective To analyze the characteristics of subclinical primary aldosteronism(SPA)by comparing the patients with SPA and primary aldosteronism(PA)with those with essential hypertension,and to observe the condition after treatment.Methods A total of 986 patients with hypertension newly diagnosed at the Department of Hypertensive Endocrinology of the Army Specialty Medical Center from September 2019 to October 2023,aged 18 to 70 years,were collected and grouped according to plasma aldosterone to renin ratio(ARR)and saline stress suppression test(SIT)results.A total of 549 patients with normal ARR screening were enrolled in the essential hypertension group(EH group),96 patients with abnormal ARR but negative SIT test were enrolled in the SPA group,and 107 patients with abnormal ARR but positive SIT test were enrolled in the PA group.The characteristics of the three groups were analyzed,and the condition after treatment in the SPA group was followed up.Results There were no significant differences in systolic or diastolic blood pressure among the three groups,but the heart rate of PA(81.8±12.2 per minute)and SPA(81.3±12.5 per minute)groups was higher than that of EH group(74.0±10.7)(P＜0.0001).Aldosterone levels in biochemical characteristics in PA(17.3 ng/dL)and SPA(11.1 ng/dL)groups were significantly higher than those in EH group(8.8 ng/dL)(P＜0.0001),while the aldosterone level in SPA group was lower than that in PA group.The ARR of PA(9.0)and SPA(6.5)groups was significantly higher than that of EH group(0.8)(P＜0.0001),and the renin level in SPA group was lower than that in PA group;the serum potassium level in PA[(3.51±0.52)mmol/L]and SPA[(3.78±0.34)mmol/L]groups was lower than that in EH[(4.02±0.31)mmol/L]group(P＜0.0001),and the serum potassium level in SPA group was higher than that in PA group.After treatment,the systolic blood pressure and diastolic blood pressure in SPA group decreased by 11.1 mmHg and 4.8 mmHg respectively.However,76.5％of SPA patients were required to take two or more drugs,and a small number of patients with poor drug response achieved complete clinical and biochemical rdlief by surgical treatment.Conclusion The clinical and biochemical characteristics of SPA are more obvious than those of patients with essential hypertension and close to those of PA,so early identification and active intervention are needed to help prevent long-term cardiovascular and cerebrovascular complications.