Determining the Prevalence of Primary Aldosteronism in Patients With New-Onset Type 2 Diabetes and Hypertension

Context: Despite a high prevalence of hypertension in diabetes and close relationship between primary aldosteronism (PA) and glucose metabolism, few study concerns the prevalence of PA in diabetes with hypertension. Objective: This study aimed to detect the prevalence of PA in patients with new-onset type 2 diabetes (T2D) and hypertension and to explore the association between PA and diabetes. Methods: A total of 256 outpatients with new-onset T2D and hypertension were screened for PA. Plasma aldosterone concentration (PAC), plasma renin activity (PRA) were measured. Patients with an aldosterone renin activity ratio (ARR) >= 30 ng/dL/ng/mL/h and PAC >= 15 ng/dL underwent confirmatory captopril challenge test (CCT) for PA. The diagnostic criteria for PA were, after CCT, (1) PAC decreased < 30%, (2) ARR maintained >= 30 ng/dL/ng/mL/h, and (3) PAC was >= 11 ng/dL. Results: Of 256 consecutive patients, 99 (39%) were positive for the screening test, and 49 (19%) were diagnosed with PA. Compared with those in groups A (screening test -) and B (screening test +, CCT -), patients in group C (diagnosed with PA) had a higher percentage of systolic blood pressure of >= 160 mmHg, less family history of hypertension, and lower serum potassium. Patients in group B and C had higher PAC and ARR levels, but lower PRA than those in group A. Homeostatic model assessment for insulin resistance (HOMA-IR) was positively associated with PAC level among the diabetic patients. Conclusion: The prevalence of PA in new-onset T2D patients with hypertension is at least 19%. Higher aldosterone may be related with insulin resistance in patients with diabetes.