Prevalence of Hypokalemia and Primary Aldosteronism in 5100 Patients Referred to a Tertiary Hypertension Unit

Primary aldosteronism (PA) was considered a rare disorder almost always associated with hypokalemia. The widespread screening of patients with hypertension unveiled an increased prevalence of PA with normokalemic hypertension the prevailing phenotype. Many studies have reported the prevalence of hypokalemia in patients with PA; conversely, the prevalence of PA in patients with hypokalemia is unknown. In this retrospective observational study, we define the prevalence of hypokalemia in referred patients with hypertension and the prevalence of PA in patients with hypokalemia and hypertension. Hypokalemia was present in 15.8% of 5100 patients with hypertension, whereas 76.9% were normokalemic, and 7.3% hyperkalemic. The prevalence of PA in patients with hypokalemia was 28.1% and increased with decreasing potassium concentrations up to 88.5% of patients with spontaneous hypokalemia and potassium concentrations <2.5 mmol/L. A multivariate regression analysis demonstrated the association of hypokalemia with the occurrence of cardiovascular events independent of PA diagnosis. An association of PA with the occurrence of cardiovascular events and target organ damage independent of hypokalemia was also demonstrated. In conclusion, our results confirm that PA is a frequent cause of secondary hypertension in patients with hypokalemia, and the presence of hypertension and spontaneous hypokalemia are strong indications for PA diagnosis. Finally, we show that PA and hypokalemia are associated with an increased risk of cardiovascular events.

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CARDIOVASCULAR EVENTS AND TARGET ORGAN DAMAGE IN PRIMARY ALDOSTERONISM

Journal of Hypertension ◽

10.1097/01.hjh.0000539344.30377.17 ◽

2018 ◽

Vol 36 (Supplement 1) ◽

pp. e133

Author(s):

S. Monticone ◽

F. D’Ascenzo ◽

C. Moretti ◽

T.A. Williams ◽

F. Veglio ◽

...

Keyword(s):

Primary Aldosteronism ◽

Cardiovascular Events ◽

Target Organ Damage ◽

Organ Damage ◽

Target Organ

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Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis

The Lancet Diabetes & Endocrinology ◽

10.1016/s2213-8587(17)30319-4 ◽

2018 ◽

Vol 6 (1) ◽

pp. 41-50 ◽

Cited By ~ 180

Author(s):

Silvia Monticone ◽

Fabrizio D'Ascenzo ◽

Claudio Moretti ◽

Tracy Ann Williams ◽

Franco Veglio ◽

...

Keyword(s):

Systematic Review ◽

Essential Hypertension ◽

Primary Aldosteronism ◽

Cardiovascular Events ◽

Meta Analysis ◽

Target Organ Damage ◽

Organ Damage ◽

Target Organ

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Abstract P182: Microangiopathic Complications In Malignant Hypertension: An Under-appreciated Form Of Target Organ Damage

Hypertension ◽

10.1161/hyp.78.suppl_1.p182 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Akhil Jain ◽

Bhumika Singhal ◽

Rishabh Jindal ◽

Chinmay Jani ◽

Puneet K Gupta

Keyword(s):

Target Organ Damage ◽

Organ Damage ◽

Pooled Analysis ◽

Target Organ ◽

Malignant Hypertension ◽

Forest Plot ◽

Significant Heterogeneity ◽

Therapeutic Implications ◽

Increased Risk ◽

Hematological Changes

Fig 1: Summary of Malignant Hypertension Studies having Microangiopathic Complications along with Forest Plot Microangiopathic Complications in Malignant Hypertension: An underappreciated form of Target Organ Damage Background: Renal thrombotic microangiopathy is a clinically important complication of malignant hypertension (MHT), but its incidence in MHT has been sparsely studied. Our aim was to study the incidence of microangiopathic changes (MaC) in MHT. Methods: We searched Google Scholar database studies directly reporting MaC (mentioning either microangiopathic hemolytic anemia or thrombotic angiopathy) in presence of MHT. We used OpenMeta[Analyst] for the pooled analysis. Results: From 1967 to 2019, 9 studies were included. Maximum likelihood random-effects method showed pooled proportion estimate of having MaC in MHT to be 0.4 (95 CI: 0.3, 0.5; p<0.1). Significant heterogeneity with I 2 =82.56%, p <0.1 was found. Subgroup analysis showed pooled proportion of MaC in MHT to be 0.5 (95 CI: 0.4,0.7, p<0.1) for studies before 2000; whereas 0.2 (95 CI: 0.2, 0.3, p<0.1) for studies after 2000. Sex-wise distribution was reported in 7 studies, risk ratio of having MaC in MHT in female was found to be 1.24 compared to male. Conclusion: Our analysis suggests decreasing incidence of MaC in MHT over the past couple of decades and increased risk of this complication in females, although significant heterogeneity exists among studies reporting microangiopathic changes in malignant hypertension. More prospective observational studies are needed to better define the epidemiology of the hematological changes that occur in MHT since they have important therapeutic implications.

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Higher pulse pressure and risk for cardiovascular events in patients with essential hypertension: The Campania Salute Network

European Journal of Preventive Cardiology ◽

10.1177/2047487317747498 ◽

2017 ◽

Vol 25 (3) ◽

pp. 235-243 ◽

Cited By ~ 26

Author(s):

Costantino Mancusi ◽

Maria A Losi ◽

Raffaele Izzo ◽

Grazia Canciello ◽

Maria V Carlino ◽

...

Keyword(s):

Pulse Pressure ◽

Cardiovascular Events ◽

Ventricular Hypertrophy ◽

Target Organ Damage ◽

Organ Damage ◽

Left Ventricular ◽

Target Organ ◽

Major Cardiovascular Events ◽

High Pulse Pressure ◽

High Pulse

Background Increased pulse pressure is associated with structural target organ damage, especially in elderly patients, increasing cardiovascular risk. Design In this analysis, we investigated whether high pulse pressure retains a prognostic effect also when common markers of target organ damage are taken into account. Methods We analysed an unselected cohort of treated hypertensive patients from the Campania Salute Network registry ( n = 7336). Participants with available cardiac and carotid ultrasound were required to be free of prevalent cardiovascular disease, with ejection fraction ≥50%, and no more than stage III Chronic Kidney Disease. The median follow-up was 41 months and end-point was occurrence of major cardiovascular events (i.e. fatal and non-fatal stroke or myocardial infarction and sudden death). Based on current guidelines, pulse pressure ≥60 mm Hg was classified as high pulse pressure ( n = 2356), at the time of the initial visit, whereas pulse pressure <60 mm Hg was considered normal ( n = 4980). Results High pulse pressure patients were older, more likely to be women and diabetic, while receiving more antihypertensive medications than normal pulse pressure (all p < 0.0001). High pulse pressure exhibited greater prevalence of left ventricular hypertrophy, and carotid plaque than normal pulse pressure (all p < 0.0001). In Cox regression, high pulse pressure patients had 57% increased hazard of major cardiovascular events, compared to normal pulse pressure (hazard ratio = 1.57; 95% confidence interval: 1.12–2.22, p = 0.01), an effect that was independent of significant prognostic impact of older age, male sex, diabetes, left ventricular hypertrophy, carotid plaque and less prescription of anti-renin–angiotensin system therapy. Conclusions High pulse pressure is a functional marker of target organ damage, predicting cardiovascular events in hypertensive patients, even independently of well-known structural markers of target organ damage.

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P3833Low heart rate variability is associated with future arrhythmic events in hypertension

European Heart Journal ◽

10.1093/eurheartj/ehz745.0674 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D Terentes-Printzios ◽

C Vlachopoulos ◽

L Korogiannis ◽

G Christopoulou ◽

P Xydis ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Heart Rate Variability ◽

Primary Endpoint ◽

Target Organ Damage ◽

Roc Curves ◽

Organ Damage ◽

Left Ventricular ◽

Target Organ ◽

Increased Risk

Abstract Background/Introduction Cardiac autonomic dysfunction and target organ damage are associated with increased cardiovascular mortality and arrhythmias. Purpose The aim of the study was to investigate the effect of heart rate variability (HRV) and markers of target organ damage in the prognosis of future arrhythmic events. Methods We studied 292 untreated at baseline hypertensives (mean age 53±13, 153 males). Cardiac autonomic function was evaluated by analysis of short-term HRV measures over 24-h using 24-h ambulatory blood pressure monitoring and the standard deviation of the measurements. Echocardiography was also performed and left ventricular mass index (LVMI) was estimated with the Demereux formula. Aortic stiffness was assessed with carotid-femoral pulse wave velocity (cfPWV) and wave reflections with aortic augmentation index corrected for heart rate (Alx@75). Patients were followed up for a median period of 13 years. The primary endpoint was a composite of atrial/ventricular tachycardias, symptomatic multiple premature ventricular contractions, second and third-degree heart blocks and pacemaker/defibrillator placement. Results In comparison without events, patients with the primary endpoint (n=37, 13%) had lower 24-h daytime HRV (9.6 beats per minute vs. 11.1 beats per minute, p=0.005), higher systolic blood pressure (168 mmHg vs. 163 mmHg, p=0.003), higher cfPWV (8.4 m/s vs. 7.7 m/s, p=0.005), higher LVMI (133 g/m2 vs. 122 g/m2, p=0.002) and higher AIx@75 (29.0% vs. 26.3%, p=0.043). In further analysis, receiver operating characteristic (ROC) curves were generated to evaluate the ability of HRV, cfPWV, LVMI and AIx@75 to discriminate subjects with arrhythmic events. The area under the curve (AUC) and 95% CIs of the ROC curves were AUC=0.35 (95% CI: 0.26–0.44, p=0.003) for HRV, AUC=0.64 (95% CI: 0.54–0.73, P<0.006) for cfPWV, AUC=0.67 (95% CI: 0.58–0.75, P=0.001) for LVMI and AUC=0.55 (95% CI: 0.47–0.64, P=0.298) for AIx@75 (Figure). In Cox regression analysis, only HRV was associated with increased risk of arrhythmic events (Hazard ratio per 1 unit =0.87, 95% Confidence intervals 0.76 to 0.995, p=0.043) when adjusted for age, gender, cfPWV, LVMI and AIx@75. ROC curves of HRV & target organ damage Conclusions Low heart rate variability is associated with increased risk of future arrhythmic events suggesting an early sympathovagal imbalance that could lead to future events in hypertension.

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