J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 10, Number 1, January 2018, pages 56-62

Primary Aldosteronism With Type 2 Diabetes Mellitus Requires More Antihypertensive Drugs for Blood Pressure Control: A Retrospective Observational Study

Figure 1. The study included a total of 70 patients. The 18 patients were diagnosed as PA with DM. As control group, 52 PA patients without DM who matched age and sex were chosen in this study. The central blood pressure was measured in 28 PA patients, including eight PA with DM and 20 PA without DM.

Figure 2. Correlation between PAC, ARR and CBP (based on CBP measurements). In the 28 PA patients for whom measured CBP values were available, a correlation was seen between PAC and CBP (r = 0.58; P < 0.01).

**Table 1.** Clinical Characteristics of 70 Patients With PA With and Without DM
	PA with DM, mean ± SD	PA without DM, mean ± SD	t-test, P value
*P < 0.05. PAC: plasma aldosterone concentration; PRA: plasma renin activity; ARR: aldosterone-to-renin ratio.
N	18	52
Age	56.3 ± 8.3	59.9 ± 9.1	0.123
Sex (male/female)	15/3	37/15	0.315
Body mass index (kg/m²)	26.4 ± 4.0	24.7 ± 3.9	0.124
HbA1c (%)	7.5 ± 1.3	5.6 ± 0.4	< 0.001*
Duration of DM (years)	5.3 ± 6.2	-
PAC (pg/mL)	210.0 ± 110.0	188.5 ± 125.7	0.521
PRA (ng/mL/h)	0.57 ± 0.44	0.37 ± 0.33	0.050
ARR	891.4 ± 1231.9	835.5 ± 906.8	0.838
ACTH (pg/mL)	25.6 ± 14.8	19.0 ± 10.6	0.053
Cortisol (µg/dL)	13.4 ± 5.8	12.6 ± 4.1	0.499
Serum potassium (mEq/L)	3.7 ± 0.7	3.6 ± 0.6	0.359
Serum creatinine (mg/dL)	0.86 ± 0.19	0.80 ± 0.19	0.224
eGFR (mL/min/1.73 m²)	71.3 ± 20.0	75.2 ± 16.7	0.422
Triglyceride (mg/dL)	153.2 ± 69.7	129.1 ± 68.7	0.205
HDL-cholesterol (mg/dL)	59.3 ± 28.4	55.4 ± 14.3	0.452
LDL-cholesterol (mg/dL)	114.4 ± 33.9	117.8 ± 31.5	0.698

Table 1. Clinical Characteristics of 70 Patients With PA With and Without DM

PA with DM, mean ± SD

PA without DM, mean ± SD

t-test, P value

*P < 0.05. PAC: plasma aldosterone concentration; PRA: plasma renin activity; ARR: aldosterone-to-renin ratio.

Age

56.3 ± 8.3

59.9 ± 9.1

0.123

Sex (male/female)

15/3

37/15

0.315

Body mass index (kg/m²)

26.4 ± 4.0

24.7 ± 3.9

0.124

HbA1c (%)

7.5 ± 1.3

5.6 ± 0.4

< 0.001*

Duration of DM (years)

5.3 ± 6.2

PAC (pg/mL)

210.0 ± 110.0

188.5 ± 125.7

0.521

PRA (ng/mL/h)

0.57 ± 0.44

0.37 ± 0.33

0.050

ARR

891.4 ± 1231.9

835.5 ± 906.8

0.838

ACTH (pg/mL)

25.6 ± 14.8

19.0 ± 10.6

0.053

Cortisol (µg/dL)

13.4 ± 5.8

12.6 ± 4.1

0.499

Serum potassium (mEq/L)

3.7 ± 0.7

3.6 ± 0.6

0.359

Serum creatinine (mg/dL)

0.86 ± 0.19

0.80 ± 0.19

0.224

eGFR (mL/min/1.73 m²)

71.3 ± 20.0

75.2 ± 16.7

0.422

Triglyceride (mg/dL)

153.2 ± 69.7

129.1 ± 68.7

0.205

HDL-cholesterol (mg/dL)

59.3 ± 28.4

55.4 ± 14.3

0.452

LDL-cholesterol (mg/dL)

114.4 ± 33.9

117.8 ± 31.5

0.698

**Table 2.** Blood Pressure and Antihypertensive Drugs of Patients With PA With and Without DM
	PA with DM, mean ± SD	PA without DM, mean ± SD	t-test, P value
*P < 0.05. CCB: calcium channel blocker; ARB: angiotensin II receptor blocker; ACEI: angiotensin-converting enzyme inhibitor; MR: mineralocorticoid receptor.
N	18	52
Duration of hypertension (years)	9.7 ± 7.7	8.7 ± 8.9	0.679
Systolic BP (mm Hg)	148.1 ± 19.5	143.9 ± 18.3	0.533
Diastolic BP (mm Hg)	87.7 ± 14.9	87.3 ± 11.6	0.907
Number of antihypertensive drugs	2.0 ± 1.5	1.3 ± 1.1	0.026*
Antihypertensive drugs ≥ 3	9 (50%)	7 (13%)	0.001*
CCB	15 (83%)	36 (69%)	0.252
ARB	6 (33%)	8 (15%)	0.104
ACEI	2 (11%)	1 (2%)	0.100
MR antagonist	1 (6%)	2 (4%)	0.762
β-blocker	7 (39%)	6 (12%)	0.010*
α-blocker	1 (6%)	8 (15%)	0.290
Diuretic drug	2 (8.0%)	3 (6%)	0.455
Vasodilator	1 (6%)	0 (0%)	0.089
Treatment
Operation	4 (22%)	17 (33%)	0.41
MR blocker	13 (72%)	30 (58%)	0.28
Other	1 (6%)	5 (9%)	0.60
Number of antihypertensive drugs after PA treatment
Operation (+)	2.5 ± 2.1	0.5 ± 1.0	0.095
(-)	2.3 ± 0.9	2.0 ± 1.1	0.129

Table 2. Blood Pressure and Antihypertensive Drugs of Patients With PA With and Without DM

PA with DM, mean ± SD

PA without DM, mean ± SD

t-test, P value

*P < 0.05. CCB: calcium channel blocker; ARB: angiotensin II receptor blocker; ACEI: angiotensin-converting enzyme inhibitor; MR: mineralocorticoid receptor.

Duration of hypertension (years)

9.7 ± 7.7

8.7 ± 8.9

0.679

Systolic BP (mm Hg)

148.1 ± 19.5

143.9 ± 18.3

0.533

Diastolic BP (mm Hg)

87.7 ± 14.9

87.3 ± 11.6

0.907

Number of antihypertensive drugs

2.0 ± 1.5

1.3 ± 1.1

0.026*

Antihypertensive drugs ≥ 3

9 (50%)

7 (13%)

0.001*

CCB

15 (83%)

36 (69%)

0.252

ARB

6 (33%)

8 (15%)

0.104

ACEI

2 (11%)

1 (2%)

0.100

MR antagonist

1 (6%)

2 (4%)

0.762

β-blocker

7 (39%)

6 (12%)

0.010*

α-blocker

1 (6%)

8 (15%)

0.290

Diuretic drug

2 (8.0%)

3 (6%)

0.455

Vasodilator

1 (6%)

0 (0%)

0.089

Treatment

Operation

4 (22%)

17 (33%)

0.41

MR blocker

13 (72%)

30 (58%)

0.28

Other

1 (6%)

5 (9%)

0.60

Number of antihypertensive drugs after PA treatment

Operation (+)

2.5 ± 2.1

0.5 ± 1.0

0.095

(-)

2.3 ± 0.9

2.0 ± 1.1

0.129

**Table 3.** Clinical Characteristics of 28 Patients for Whom Measured Central Blood Pressure
	PA with DM, mean ± SD	PA without DM, mean ± SD	t-test, P value
*P < 0.05. PAC: plasma aldosterone concentration; PRA: plasma renin activity; ARR: aldosterone-to-renin ratio.
N	8	20
Age	65.0 ± 13.0	51.6 ± 10.8	0.009*
Sex (male/female)	7/1	5/15	0.485
Body mass index (kg/m²)	25.9 ± 5.0	24.9 ± 2.5	0.496
HbA1c (%)	7.3 ± 1.3	5.44 ± 0.4	< 0.001*
PAC (pg/mL)	240.3 ± 118.5	138.6 ± 48.6	0.003*
PRA (ng/mL/h)	0.6 ± 0.4	0.5 ± 0.3	0.611
ARR	530.2 ± 282.1	414.8 ± 297.3	0.356
Duration of hypertension (years)	11.7 ± 9.1	7.7 ± 9.1	0.343
Central BP (mm Hg)	151.0 ± 28.3	137.5 ± 13.7	0.200
Systolic BP (mm Hg)	148.0 ± 18.7	143.9 ± 21.6	0.642
Diastolic BP (mm Hg)	86.5 ± 13.4	87.7 ± 15.9	0.853

Table 3. Clinical Characteristics of 28 Patients for Whom Measured Central Blood Pressure

PA with DM, mean ± SD

PA without DM, mean ± SD

t-test, P value

*P < 0.05. PAC: plasma aldosterone concentration; PRA: plasma renin activity; ARR: aldosterone-to-renin ratio.

Age

65.0 ± 13.0

51.6 ± 10.8

0.009*

Sex (male/female)

7/1

5/15

0.485

Body mass index (kg/m²)

25.9 ± 5.0

24.9 ± 2.5

0.496

HbA1c (%)

7.3 ± 1.3

5.44 ± 0.4

< 0.001*

PAC (pg/mL)

240.3 ± 118.5

138.6 ± 48.6

0.003*

PRA (ng/mL/h)

0.6 ± 0.4

0.5 ± 0.3

0.611

ARR

530.2 ± 282.1

414.8 ± 297.3

0.356

Duration of hypertension (years)

11.7 ± 9.1

7.7 ± 9.1

0.343

Central BP (mm Hg)

151.0 ± 28.3

137.5 ± 13.7

0.200

Systolic BP (mm Hg)

148.0 ± 18.7

143.9 ± 21.6

0.642

Diastolic BP (mm Hg)

86.5 ± 13.4

87.7 ± 15.9

0.853

**Table 4.** Multiple Regression Analysis of PAC With CBP
	Standardized coefficient (β)	P value	Adjust R²
*P < 0.05.
			0.239
PAC	0.566	0.006*
Age	-0.021	0.916
Sex	-0.096	0.619
BMI	0.035	0.851

Table 4. Multiple Regression Analysis of PAC With CBP

Standardized coefficient (β)

P value

Adjust R²

*P < 0.05.

0.239

PAC

0.566

0.006*

Age

-0.021

0.916

Sex

-0.096

0.619

BMI

0.035

0.851