Exp Clin Endocrinol Diabetes 2013; 121 - P80
DOI: 10.1055/s-0033-1336758

Female patients with primary aldosteronism are diagnosed earlier and have a better cardiovascular outcome after treatment

E Fischer 1, A Pallauf 2, C Adolf 1, P Jung 3, C Degenhart 4, K Hallfeldt 5, M Bidlingmaier 1, F Beuschlein 1, M Reincke 1
  • 1Medizinische Klinik und Poliklinik IV; LMU, Endocrinology, Munich, Germany
  • 2Ludwig-Maximilans-Universität, Medizinische Klinik Innenstadt, München, Germany
  • 3Medizinische Klinik und Poliklinik I; LMU, Cardiology, Munich, Germany
  • 4Institut für klinische Radiologie, LMU München, Munich, Germany
  • 5Chirurgische Klinik Innenstadt, LMU München, Munich, Germany

Introduction: Primary aldosteronism (PA) is the most frequent curable form of hypertension. Although early diagnosis is important because of associated cardiovascular and renal morbidity, PA often goes undiagnosed for many years. Our aim was to study the influence of sex on diagnosis and outcome in a cohort of PA patients.

Methods: A total of 73 consecutive patients prospectively studied since 2008 in the Munich center of the German Conn's Registry were analyzed at diagnosis and 1 year after specific treatment (adrenalectomy or mineralocorticoid antagonist treatment).

Results: Median age at diagnosis was 53 (43;60) years. Female patients (n = 26, 36%) were diagnosed earlier than males [43.1 (37.3; 49.5) vs. 58.2 (46.7; 63.3) y, p < 0.001]. The time from the initial recognition of hypertension to the diagnosis of PA was 8 (5; 22) y, with 7 (1; 12) in females vs. 10 (5; 24) y in males (p = 0.028). Although different by age, other baseline parameters, such as blood pressure [(157 (146;181)/94 (89;100) vs. 160 (149;180)/94 (87;105) mmHg, p = 0.557/0.944], minimal serum potassium concentration [2.8 (2.4;3.0) vs. 2.9 (2.7;3.2) mmol/L, p = 0.334] or cardiovascular and metabolic comorbidities did not differ between sexes. At 1 year follow-up, 98% of all operated patients had biochemical remission. Median ambulant blood pressure was reduced from 160 (148;180)/94 (87;105) to 139 (128;147)/86 (78;93) mmHg in all patients (p < 0.001), with no differences between sexes. Male patients were taking more antihypertensive drugs compared to female patients [3(2;4) vs. 1(0;2), p < 0.001]. Females were significantly less likely to have renal insufficiency (12 vs. 38%, p = 0.016), left ventricular hypertrophy (14 vs. 42%, p = 0.021) or coronary artery disease (0% vs. 16%, p = 0.029).

Conclusion: Women with PA are diagnosed 15 years younger than men and have a shorter history of arterial hypertension. Specific treatment improves cardiovascular outcome in both sexes but this effect is much more pronounced in females.