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Prevalence of primary aldosteronism (PA) nationwide in Italy in newly diagnosed hypertensive patients
AJH–May 2004 –VOL. 17, NO. 5, PART 2
P-565 PLATELET ACTIVITY IN HYPERTENSIVE PATIENTS Galina N Potapova, Lyfdmila I L. Bouriachkovskaja, Vera K Sitina, Irina A Uchitel, Guram G Arabidze. General Clinical Department, Russian Cardiology Research Complex, Moscow, Russian Federation. Platelet activity was compared in healthy subjects (HS) and in patients with different forms of arterial hypertension: essential hypertension (EH), diseases of renal parenchyma (DRP), pheochromocytoma (P) and nonspecific aortoarteritis (NA). We studied platelet morphology by scanning electron microscopy and spontaneous (SPA) and ADP-induced aggregation by aggregation analyzer model LA230 Biola Ltd, Russia. In patients with EH, DRP and NA there was redistribution of platelet pool by decreasing of discs (from 41.3⫾3.6% to 51.7⫾7.2% on the contrary to 85.3⫾7.2% in HS) and increasing of spheres (from 44.6⫾7.1% to 56.3⫾2.3% on the contrary to 11.8⫾2,7% in HS). EH patients with verified coronary atherosclerosis (CA) had redistributed platelet pool not only by significant decrease of discs and increase of spheres, but by appearance of large platelets (9.3⫾0.8%). In patients with P redistribution was mainly related to decrease of discs (to 46.6⫾2.9%) and especially to increase of bypolars (32.8⫾3.5% on the contrary to 2.9⫾0.7% in HS). SPA was only incresed in EH patients with CA. ADP-induced aggregaton was marked decreased in patients with P. In patients with EH, DRP and NA platelet activity was slightly increased, but in cases of EH with CA platelets were very active. In patients with P platelet activity was significntly decreased. In patients with EH, DRP and NA treatment by inhibitors of ACE, betablockers and calcium-antagonists did not change morpho-functional characteristics of platelets, but in patients with P there was normalizaton of these platelet functions by using alphablockers. Key Words: Platelet, Hypertension, Treatment
P-566 ASSOCIATION OF CAROTID LESIONS WITH VASOACTIVATORS IN HYPERTENSIVE PATIENTS Chen Qiling, Sun Ningling. Hypertensive Department, People’s Hospital, Peking’s University, Beijing, China. Aim: To access the relationship between carotid lesions and some vasoactivators nitric oxide, endothelin in patients with hypertension. Methods: 120 hypertensive patients were devided into four groups based on the result of carotid arterial sonography: Normal group(30 cases), endothelial thickness group(30 cases), hard plaque group(30 cases) and soft plaque group(30 cases). Several vasoactivators were determined in these patients, including nitrogen monoxide(NO), endothelin(ET),before and post treament on hypertension. Results: Compared with non-plaque group, soft plaque group had lower levels of NO,the difference was significant(P⬍0.05).Hard plaque group had also different levels of above vasoactivor parameters from those of normal group (P⬍0.05).The patients whose blood pressure became normal have low levels of stroke than those unnormal. The protection on blood vessel also was more effective. Conclusion: There was a significant association between the formation of carotid atherosclerotic lesions and the hypertensive injury and disorders of lipids metabolism.So the protection on the blood vessel must base on the effective treatment on hypertension. Key Words: MeSH Hypertension, Carotid Atherosclerotic Plaque, Vasoactivator
POSTERS: Secondary Hypertension
239A
P-567 PREVALENCE OF PRIMARY ALDOSTERONISM (PA) NATIONWIDE IN ITALY IN NEWLY DIAGNOSED HYPERTENSIVE PATIENTS Gian Paolo Rossi *, Franco Mantero *. DMCS, Clinica Medica 4, University of Padova, Padova, Italy; Division of Endocrinology, University of Padova, Padova, Italy. Background: It has been contended that PA is the most frequent endocrine cause of hypertension (H); however, its prevalence in hypertensive patients is currently unknown. Objective: to prospectively estimate the prevalence of PA in newly diagnosed hypertensive patients nationwide in Italy with pre-specified diagnostic criteria. Design and Methods: Consecutive newly diagnosed (WHO/ISH criteria) hypertensive patients referred to 20 centers for H scattered all over Italy underwent a standard diagnostic protocol. The latter entailed a screening test, e.g. measurement of sitting PRA and Aldosterone, baseline and after Captopril (50 mg p.o.), of serum Na⫹ and K⫹ levels and of 24 hr urinary excretion. One every 4 patients and all those with an aldosterone (ng/dl)/PRA (ng/ml/h) ratio ⬎ 40 under basal conditions, and/or ⬎ 30 after captopril, and/or a score of probability of PA (by logistic discriminant function, LDF, as described Clin Endocrinol 1998) ⬎0.50 underwent a standard confirmation test (saline suppression) and an imaging test (TC or MR) for identification of underlying adrenal pathology. Adrenal vein sampling was also performed whenever necessary. Results: From December 2001 to November 2003, 707 patients (57% m and 43% f; age: 46⫾12 yrs) underwent the screening test. PA prevalence, calculated according to the aforementioned (Table), was found elevated (about 20%), using both the Aldo/PRA ratio and the LDF score. It resulted to be lower when the Aldo/PRA ratio after captopril was used. Of the patients selected for a positive screening test 43% had values of Aldo/PRA ⬎7.5 ng/dl at the confirmation test. Of the 372 patients in whom a definitive diagnosis was eventually made, 8.3% had confirmed PA. However, a significant heterogeneity of PA prevalence across centers (p⬍0.001) was found.
Criteria
Also/PRA baseline >40
Score FLD >0.50
Also/PRA after capt. >30
Prevalence (%)
19.5
26.3
13.6
Conclusions: These results evidenced: 1) the feasibility of a multicenter study aimed to assessing the prevalence of PA nationwide with a standard diagnostic protocol; 2) a high prevalence of PA in newly diagnosed hypertensive patients referred to H centers nationwide in Italy, albeit with remarkable differences between centers. * For the Working Group on Conn’s Syndrome of the Italian Society for Arterial Hypertension Key Words: Primary Aldosteronism, Prevalence
P-568 APPARENT PREVALENCE OF PRIMARY ALDOSTERONISM IN A REFERRAL PRACTICE: A RETROSPECTIVE STUDY Vani Selvan, Ronald D Smith, Pavel J Levy, Carlos M Ferrario. The Hypertension and Vascular Disease Center, Wake Forest University School of Medicine, Winston-Salem, NC. Primary aldosteronism (PA), as first describe by Conn in 1955, has undergone conceptual revision in the last 20 years. First thought to exist as a rare entity, revisionists have presented newer criteria and detection methods increasing the original 0.5% incidence to as high as 32%. This retrospective study seeks to determine the apparent prevalence of PA in a referral clinic. The Aldosterone Renin Ratio (ARR) introduced in 1973 has become a principle element for clinical diagnosis, and consequently has engendered great discussion and some controversy. This study ret-
P-565 PLATELET ACTIVITY IN HYPERTENSIVE PATIENTS Galina N Potapova, Lyfdmila I L. Bouriachkovskaja, Vera K Sitina, Irina A Uchitel, Guram G Arabidze. General Clinical Department, Russian Cardiology Research Complex, Moscow, Russian Federation. Platelet activity was compared in healthy subjects (HS) and in patients with different forms of arterial hypertension: essential hypertension (EH), diseases of renal parenchyma (DRP), pheochromocytoma (P) and nonspecific aortoarteritis (NA). We studied platelet morphology by scanning electron microscopy and spontaneous (SPA) and ADP-induced aggregation by aggregation analyzer model LA230 Biola Ltd, Russia. In patients with EH, DRP and NA there was redistribution of platelet pool by decreasing of discs (from 41.3⫾3.6% to 51.7⫾7.2% on the contrary to 85.3⫾7.2% in HS) and increasing of spheres (from 44.6⫾7.1% to 56.3⫾2.3% on the contrary to 11.8⫾2,7% in HS). EH patients with verified coronary atherosclerosis (CA) had redistributed platelet pool not only by significant decrease of discs and increase of spheres, but by appearance of large platelets (9.3⫾0.8%). In patients with P redistribution was mainly related to decrease of discs (to 46.6⫾2.9%) and especially to increase of bypolars (32.8⫾3.5% on the contrary to 2.9⫾0.7% in HS). SPA was only incresed in EH patients with CA. ADP-induced aggregaton was marked decreased in patients with P. In patients with EH, DRP and NA platelet activity was slightly increased, but in cases of EH with CA platelets were very active. In patients with P platelet activity was significntly decreased. In patients with EH, DRP and NA treatment by inhibitors of ACE, betablockers and calcium-antagonists did not change morpho-functional characteristics of platelets, but in patients with P there was normalizaton of these platelet functions by using alphablockers. Key Words: Platelet, Hypertension, Treatment
P-566 ASSOCIATION OF CAROTID LESIONS WITH VASOACTIVATORS IN HYPERTENSIVE PATIENTS Chen Qiling, Sun Ningling. Hypertensive Department, People’s Hospital, Peking’s University, Beijing, China. Aim: To access the relationship between carotid lesions and some vasoactivators nitric oxide, endothelin in patients with hypertension. Methods: 120 hypertensive patients were devided into four groups based on the result of carotid arterial sonography: Normal group(30 cases), endothelial thickness group(30 cases), hard plaque group(30 cases) and soft plaque group(30 cases). Several vasoactivators were determined in these patients, including nitrogen monoxide(NO), endothelin(ET),before and post treament on hypertension. Results: Compared with non-plaque group, soft plaque group had lower levels of NO,the difference was significant(P⬍0.05).Hard plaque group had also different levels of above vasoactivor parameters from those of normal group (P⬍0.05).The patients whose blood pressure became normal have low levels of stroke than those unnormal. The protection on blood vessel also was more effective. Conclusion: There was a significant association between the formation of carotid atherosclerotic lesions and the hypertensive injury and disorders of lipids metabolism.So the protection on the blood vessel must base on the effective treatment on hypertension. Key Words: MeSH Hypertension, Carotid Atherosclerotic Plaque, Vasoactivator
POSTERS: Secondary Hypertension
239A
P-567 PREVALENCE OF PRIMARY ALDOSTERONISM (PA) NATIONWIDE IN ITALY IN NEWLY DIAGNOSED HYPERTENSIVE PATIENTS Gian Paolo Rossi *, Franco Mantero *. DMCS, Clinica Medica 4, University of Padova, Padova, Italy; Division of Endocrinology, University of Padova, Padova, Italy. Background: It has been contended that PA is the most frequent endocrine cause of hypertension (H); however, its prevalence in hypertensive patients is currently unknown. Objective: to prospectively estimate the prevalence of PA in newly diagnosed hypertensive patients nationwide in Italy with pre-specified diagnostic criteria. Design and Methods: Consecutive newly diagnosed (WHO/ISH criteria) hypertensive patients referred to 20 centers for H scattered all over Italy underwent a standard diagnostic protocol. The latter entailed a screening test, e.g. measurement of sitting PRA and Aldosterone, baseline and after Captopril (50 mg p.o.), of serum Na⫹ and K⫹ levels and of 24 hr urinary excretion. One every 4 patients and all those with an aldosterone (ng/dl)/PRA (ng/ml/h) ratio ⬎ 40 under basal conditions, and/or ⬎ 30 after captopril, and/or a score of probability of PA (by logistic discriminant function, LDF, as described Clin Endocrinol 1998) ⬎0.50 underwent a standard confirmation test (saline suppression) and an imaging test (TC or MR) for identification of underlying adrenal pathology. Adrenal vein sampling was also performed whenever necessary. Results: From December 2001 to November 2003, 707 patients (57% m and 43% f; age: 46⫾12 yrs) underwent the screening test. PA prevalence, calculated according to the aforementioned (Table), was found elevated (about 20%), using both the Aldo/PRA ratio and the LDF score. It resulted to be lower when the Aldo/PRA ratio after captopril was used. Of the patients selected for a positive screening test 43% had values of Aldo/PRA ⬎7.5 ng/dl at the confirmation test. Of the 372 patients in whom a definitive diagnosis was eventually made, 8.3% had confirmed PA. However, a significant heterogeneity of PA prevalence across centers (p⬍0.001) was found.
Criteria
Also/PRA baseline >40
Score FLD >0.50
Also/PRA after capt. >30
Prevalence (%)
19.5
26.3
13.6
Conclusions: These results evidenced: 1) the feasibility of a multicenter study aimed to assessing the prevalence of PA nationwide with a standard diagnostic protocol; 2) a high prevalence of PA in newly diagnosed hypertensive patients referred to H centers nationwide in Italy, albeit with remarkable differences between centers. * For the Working Group on Conn’s Syndrome of the Italian Society for Arterial Hypertension Key Words: Primary Aldosteronism, Prevalence
P-568 APPARENT PREVALENCE OF PRIMARY ALDOSTERONISM IN A REFERRAL PRACTICE: A RETROSPECTIVE STUDY Vani Selvan, Ronald D Smith, Pavel J Levy, Carlos M Ferrario. The Hypertension and Vascular Disease Center, Wake Forest University School of Medicine, Winston-Salem, NC. Primary aldosteronism (PA), as first describe by Conn in 1955, has undergone conceptual revision in the last 20 years. First thought to exist as a rare entity, revisionists have presented newer criteria and detection methods increasing the original 0.5% incidence to as high as 32%. This retrospective study seeks to determine the apparent prevalence of PA in a referral clinic. The Aldosterone Renin Ratio (ARR) introduced in 1973 has become a principle element for clinical diagnosis, and consequently has engendered great discussion and some controversy. This study ret-