Session: SAT-LB-Late-Breaking Poster Session 1
Bench to Bedside
Poster Board SAT-LB-10
Method: 440 patients (197 men, women 243, age 53.74±12.12) with hypertension in the Tohoku University hospital from July 2009 to December 2011 were recruited. We unified the antihypertensive medications only to Ca antagonist and alpha blocker before measuring TTKG.All patients were measured TTKG and performed captopril loading test (CAPT: captopril 50 mg PO). The patients with basal ARR>20 and ARR in CAPT>20 were diagnosed as PA and successively performed adrenal vein sampling (AVS) .
Results: 284/440 patients were diagnosed as PA and 132/284 patients presented with unilateral excessive aldosterone secretion and were underwent adrenalectomy as aldosterone producing adenoma (APA).In PA patients, 37/284 patients(13%) had hypokalemia(serum potassium < 3.5mEq/l), nevertheless, 168/284 patients(59.2%) had relatively high TTKG( 4.95±0.12).This data indicate that even the PA patients have normal serum potassium level, TTKG may have already increased. Next, we investigated the relationship between PAC and TTKG, PAC and Urine K/ Urine Na, PAC and FEk(%).TTKG showed a correlation to PAC (R= 0.514, p<0.01), significantly compared to Urine K/ Urine Na and FEk. When we divided all patients into two groups (group A: PAC≥12.0ng/ml, group B: PAC<12.0ng/ml ), TTKG was significantly high level in a group A(6.00±3.10 in group A vs. 4.11±1.60 in group B).When we divided PA patients into two groups (group S: surgical treatment group, group M: medical treatmt group), TTKG was significantly high level in a group S (5.82±3.05 in group S vs. 4.24±1.81 in group M). Multivariate regression analysis revealed that Age, eGFR and TTKG were independent predictors of PAC in all cases. By extension, multivariate logistic analysis revealed that TTKG was independently related to Treatment (whether or not surgical treatment finally chosen after AVS) in PA patients (odds ratio:1.247, 95% confidence interval[1.087-1.431]] for TTKG, p<0.01) , in addition to Age and PAC.
Conclusion: In addition to ARR, measuring TTKG in hypertensive patients may be useful for screening PA. The level of TTKG(>4.0) can predict relatively high level of PAC (>12.0 ng/ml) .
Nothing to Disclose: MK, RM, YI, YO, MN, KM, SI, FS
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