Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 723-757-Renin-Angiotensin-Aldosterone System/Endocrine Hypertension
Bench to Bedside
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-749
Sandi-Jo Galati*1, Sarah M Hopkins2, Khadeen C Cheesman2, Rachel A Zhuk2, Tiffany K Ying2, Chelsey Amer3, Michael K Boyajian4, Emilia Bagiella2 and Alice C Levine5
1Mount Sinai Medical Ctr, New York, NY, 2Icahn School of Medicine at Mount Sinai, 3Sackler School of Medicine, 4Columbia University, 5Mt Sinai Med Ctr, New York, NY
Background:  Primary aldosteronism (PA) has emerged as the leading cause of identifiable endocrine hypertension (HTN) over the last twenty years.  Recent studies in Australia, Singapore, and Italy have demonstrated a higher prevalence of PA than the historical estimates of 1%, with reports of 5-12% in populations with essential HTN.  The prevalence is even higher in certain sub-populations, such as those with diabetes and HTN (13-14%), resistant HTN (19-20%), and obstructive sleep apnea and HTN (34%).   Despite this, the prevalence of PA has not been characterized in an urban population with HTN in the United States. 

Hypothesis/Methods:  We hypothesize that the prevalence of PA in our outpatient, New York City population exceeds prior estimates of 1% of patients with HTN and is closer to recent estimates of 5% or more.  400 patients must be recruited to detect a prevalence of 5% or more.  All adult patients with HTN, creatinine less than 1.5 mg/dL, no prior evaluation for PA, and no systemic glucocorticoid or mineralocorticoid-receptor (MR) antagonist use are eligible to be screened with the aldosterone-renin ratio (ARR).  With the exception of MR-antagonists, ARR is interpreted in the context of the known effects of all other anti-HTN agents.  Those patients with ARR > 20 ng/dL per ng/mL/hour and plasma aldosterone concentration (PAC) > 10 ng/dL are further evaluated with IV saline load confirmation.

Results: 204 patients have been recruited, 68.1% female (n=139) and 31.9% male (n=65), average age 60 ± 6.4 years. Of these, 54.9% identify themselves as Hispanic (n=112), 37.3% Black (n=76), 5.9% Caucasian (n=12), and 1.9% other (n=4).  35.3% have uncontrolled HTN (defined as blood pressure  > 140/90).  The average number of anti-HTN agents prescribed is 2.1 ± 1. 180 ARR results have been interpreted.  Of these, one patient has an ARR > 20 ng/dL per ng/mL/hour with PAC >10 ng/dL, with an overall prevalence of 0.56%.  These preliminary results suggest PA may be less prevalent in our particular population than in recent reports, however a larger sample size is required in order to disprove the null hypothesis.

Conclusions:  Our preliminary data indicates that the PA prevalence in our urban hypertensive population is less than 5%.  If these findings are substantiated with a larger sample size, possible explanations for the discrepancy between our data and that reported in the more recent literature include the ethnic heterogeneity of our population and the inclusion of all patients with hypertension, regardless of the severity.

Nothing to Disclose: SJG, SMH, KCC, RAZ, TKY, CA, MKB, EB, ACL

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