Clinical Study Of 150 Patients With Primary Aldosteronism

Objective:This study aims to observe the clinical characteristics of 150 patients with primary aldosteronism(PA),and to explore the correlation between serum potassium and urinary microprotein and arteriosclerosis,as well as the correlation between blood pressure rhythm and 24 h urinary microprotein(24h UMALB)and arteriosclerosis,so as to provide reference for the early assessmentof targetorgan damages in clinical patients with primary aldosteronism.Methods:A total of 150 patients who diagnosed with PA in the hypertensive ward of the First Affiliated Hospital of Guangxi Medical University from August 2014 to January 2018 were collected.Record the age,sex,body mass index(BMI),serumpotassium,blood lipid,blood glucose,glycosylated hemoglobin,kidney function,standing plasma aldosterone(PAC),and standing plasma renin activity(PRA),standing angiotensin(AT),cortisol,ambulatory blood pressure parameters,pulse wave velocity(PWV),carotid intima-media thickness(IMT)and 24 h microalbuminuria,etc.We divided the study population into different groups,according to age,serum potassium level and blood pressure rhythm,to compare whether there were differences in the standards of each group.Multivariate regression analysis of factors affecting serum potassium,blood pressure rhythm and 24-hour microalbuminuria.Results:1)The distribution of PA was the highest in the age group of 30 to 55,reaching 76%.2)In PA,28% of patients had metabolic syndrome,8% hadObstructive sleep apnea(OSA),and 6% had diabetes.3)There were 37 patients of hypokalemia accounting for 24.7%.Compared with potassium normal group,standing PAC,24 hour mean Systolic blood pressure(SBP),daytime mean SBP,night mean SBP,24 h U-MALB,24 hour urine protein,Urine microalbumin ratio Urine creatinine were significantly increased in hypokalemia group(P< 0.05),while the total cholesterol(TC),triglyceride(TG),glycosylated hemoglobin,average heart rate were significantly lower(P< 0.05).And between the two groups,age,gender,smoking,duration of hypertension,BMI,highdensity lipoproteincholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),homocysteine(HCY),fasting blood sugar,2 hour postprandial blood glucose,urea nitrogen(BUN),Creatinine(Cr),Creatinine clearance rate(Ccr),uric acid,standing standing PRA,standing AT II,standing ARR,Cortisol rhythm,24 hour mean diastolic blood pressure(DBP),daytime mean DBP,night mean DBP,Ambulatory Arterial Stiffness Index(AASI),Intimamedia thickness(IMT),pulse wave velocity(PWV)comparison had no significant difference(P> 0.05).4)Non-dipper was main type in all PA patients,accounting for 60%.Compared with the dipper group,the reverse-dipper of the standing PRA increased(P< 0.05),but the standing ARR value decreased(P < 0.05).There was no significant difference of the three groups,between the dipper,the non-dipper and the reverse-dipper,in age,gender,smoking,duration of hypertension,BMI,blood lipid,blood sugar,uric acid,standing PAC,standing ATII,cortisol rhythm,24-hour mean(SBP,DBP),daytime mean(SBP,DBP),AASI,24 h UMALB,24 h urine protein,IMT and PWV(P> 0.05).5)Multivariate regression analysis showed that BMI and glycosylated hemoglobin were positively correlated with serum potassium level(P< 0.05),while standing PAC,24 h U-MALB and 24 h mean SBP were negatively correlated(P< 0.05).Serum potassium was negatively correlated with 24 h U-MALB(P< 0.05).Conclusion: According to the study on the clinical characteristics of 150 patients with PA,it was found that: The distribution of PA was the highest in the age group of 30 to 55 reaching 76%.Non-dipper was main type in all PA patients accounting for 60%.28% of patients had metabolic syndrome,24.7% had hypokalemia,8% had OSA and 6% had diabetes.Microalbumin and mean systolic blood pressure(24h,daytime and night)were higher in patients with hypokalemia in PA.There was a negativecorrelation betweenserum potassium level and level of standing aldosteronism,24 h mean SBP and 24hU-MALB.The results suggest that hypokalemia may be an early indicator of renal damage in patient with primary aldosteronism.