Abstract: SA-PO540
Prevalence of Aldosterone Breakthrough in a Cardiometabolic Clinic and Association with Albuminuria
Session Information
- Hypertension and CVD: Clinical - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Imcaoudene, Ahmed Rateb, McGill University Health Centre, Montreal, Quebec, Canada
- Najjar, Caroline, McGill University Health Centre, Montreal, Quebec, Canada
- Marques, Pedro, McGill University Health Centre, Montreal, Quebec, Canada
- Tsoukas, Michael A., McGill University Health Centre, Montreal, Quebec, Canada
- Sharma, Abhinav, McGill University Health Centre, Montreal, Quebec, Canada
- Mavrakanas, Thomas, McGill University Health Centre, Montreal, Quebec, Canada
Background
Type 2 diabetes (T2D) and chronic kidney disease (CKD) patients have cardiovascular and renal benefits when treated with renin-angiotensin system (RAS) blockers. Some of these patients are known to exhibit a rise in aldosterone levels while on RAS blockers, called aldosterone breakthrough. The aim of our study is to assess the prevalence of aldosterone breakthrough in our clinic and its association with albuminuria.
Methods
Patients from a cardiometabolic clinic with available plasma aldosterone concentration (PAC) levels were screened. Exclusion criteria included: not taking a RAS blocker for at least 10 months, current treatment with a mineralocorticoid receptor antagonist (MRA) and an Aldosterone to renin ratio suggestive of primary hyperaldosteronism. Patients with a PAC>400pmol/L were considered to have aldosterone breakthrough.
Results
64 patients met the inclusion criteria with 21 (33%) showing aldosterone breakthrough. Patient characteristics are shown in the Table. No significant differences in baseline characteristics were seen in patients with or without aldosterone breakthrough except for higher albuminuria in the breakthrough group. The prevalence of CKD was numerically higher in the breakthrough group. Similar trends were seen when aldosterone breakthrough was defined as a PAC level above the median of our sample.
Conclusion
Aldosterone breakthrough is prevalent in patients from a cardiometabolic clinic and is associated with higher albuminuria. Patients with aldosterone breakthrough can potentially draw more benefit when treated with an MRA.
Baseline characteristics based on the presence or absence of aldosterone breakthrough
| Characteristic | Aldosterone breakthrough | No aldosterone breakthrough | p value |
| Age (years, median [IQR]) | 67 (64-77) | 67 (61-75) | 0.58 |
| Sex (male, [n,%]) | 15 (71) | 28 (65) | 0.61 |
| Hypertension (n, %) | 19 (90) | 37 (86) | 0.62 |
| Type 2 diabetes (n, %) | 20 (95) | 40 (93) | 0.73 |
| Heart Failure (n, %) | 13 (62) | 23 (53) | 0.52 |
| Chronic kidney disease* (n, %) | 16 (76) | 22 (51) | 0.06 |
| SGLT2i (n, %) | 16 (76) | 35 (81) | 0.63 |
| Albuminuria (mg/g, [median (IQR)]) | 264 (76-1118) | 34 (0-1013) | 0.02 |
| PAC (pmol/L, [median (IQR)]) | 549 (498-839) | 227 (151-291) | <0.01 |
*defined as eGFR<60mL/min/1.73m2 IQR - Interquartile range; PAC - Plasma aldosterone concentration; SGLT2i - sodium-glucoseco-transporter 2 inhibitors.