Risk of new-onset diabetes mellitus in primary aldosteronism: A population study over 5 years
Journal
Journal of Hypertension
Journal Volume
35
Journal Issue
8
Pages
1698-1708
Date Issued
2017
Author(s)
Abstract
Objective: Abnormal glucose metabolism due to insulin resistance has been linked to aldosterone overproduction. However, the long-term incidence of new-onset diabetes mellitus (NODM) among patients with primary aldosteronism after targeted treatment has not been well documented. Methods: The diagnosis of primary aldosteronism and essential hypertension were identified, and then the occurrence of NODM, all-cause mortality among these patients, was ascertained by a validated algorithm from a 23-million population insurance registry. Results: From 1999 to 2007, 2367 primary aldosteronism patients without previously diabetes mellitus were identified and propensity score-matched with 9468 patients with essential hypertension. Among those primary aldosteronism patients, 754 aldosterone-producing adenomas patients were identified and matched with 3016 essential hypertension controls. After a mean 5.2 years of follow-up, primary aldosteronism patients who underwent adrenalectomy had an attenuated NODM incidence (hazard ratio = 0.60, P < 0.01, versus essential hypertension); whereas those treated with mineralocorticoid receptor antagonist had augmented risk of NODM (hazard ratio = 1.16, P < 0.001, versus essential hypertension). Among the aldosterone-producing adenoma patients, adrenalectomy is also protective from developing NODM (hazard ratio = 0.61, P < 0.001, versus essential hypertension), however, mineralocorticoid receptor antagonist treatment did not alter the risk of NODM (P = 0.10, versus essential hypertension). Adjusted hazard ratios for long-term risk of mortality from this analysis revealed that adrenalectomy is protective, but NODM and major cardiovascular disease are deleterious. Conclusion: The primary aldosteronism patients who underwent adrenalectomy had reduced risk for incident NODM and all-cause of mortality, compared with matched hypertensive controls. This observation adds more evidence on the association of primary aldosteronism with a higher risk of metabolic syndrome and long-term mortality. ? 2017 Wolters Kluwer Health, Inc. All rights reserved.
SDGs
Other Subjects
alpha adrenergic receptor blocking agent; angiotensin receptor antagonist; beta adrenergic receptor blocking agent; calcium channel blocking agent; clopidogrel; dipeptidyl carboxypeptidase inhibitor; diuretic agent; histamine H2 receptor antagonist; hydroxymethylglutaryl coenzyme A reductase inhibitor; nitrate; proton pump inhibitor; serotonin uptake inhibitor; steroid; ticlopidine; uricosuric agent; warfarin; mineralocorticoid antagonist; adrenalectomy; adult; antihypertensive therapy; Article; cohort analysis; comorbidity; controlled study; diabetes mellitus; essential hypertension; female; follow up; hormonal therapy; human; hyperlipidemia; hyperuricemia; incidence; major clinical study; male; middle aged; mortality; mortality risk; new onset diabetes mellitus; primary hyperaldosteronism; priority journal; risk; complication; diabetes mellitus; diagnosis related group; hyperaldosteronism; hypertension; propensity score; risk factor; statistics and numerical data; Taiwan; Adrenalectomy; Diabetes Mellitus; Diagnosis-Related Groups; Female; Humans; Hyperaldosteronism; Hypertension; Incidence; Male; Middle Aged; Mineralocorticoid Receptor Antagonists; Propensity Score; Risk Factors; Taiwan
Publisher
Lippincott Williams and Wilkins
Type
journal article