Analysis of clinical characteristics of patients with resistant hypertension in primary aldosteronism

doi:10.16150/j.1671-2870.2025.04.012

Abstract

Abstract:

Objective To compare the clinical characteristics of resistant hypertension (RH) in patients with primary aldosteronism (PA) and essential hypertension (EH), and to analyze the risk factors associated with RH. Methods From January 2010 to December 2014, a total of 2 138 consecutive patients referred to our department for screening the causes of hypertension were enrolled. The prevalence of RH was calculated. Among them, 385 patients (18.0%) were classified into the PA group, and 385 patients with EH matched based on age, gender, blood pressure (BP) levels were selected as the EH group. The prevalence of RH and general clinical data between the two groups were compared, and the relationship between RH and left ventricular hypertrophy (LVH) in patients with PA and EH was analyzed. Multiple linear regression analysis was used to identify risk factors for RH. Results RH accounted for approximately 26.0% (556/2 138) of the inpatients in the department of hypertension, and 9.2% (51/556) of these RH patients were diagnosed with PA. The prevalence of RH in the PA group was significantly lower than that in the EH group (13.2% vs 35.3%, P<0.001). There was no significant difference in the incidence of LVH between RH and non-RH patients in the PA group (59.3% vs 56.9%). In the EH group, the incidence of LVH was much higher in RH patients than in non-RH patients (54.3% vs 30.1%, P<0.05). Multivariate regression analysis showed that office systolic blood pressure, male gender, and diabetes were independent risk factors for RH in PA patients. The occurrence of RH in the EH group was independently correlated with age, hypertension course, LVH, and creatinine level (P<0.05). Conclusions The prevalence of RH among hypertensive inpatients is approximately 26.0%. In PA and EH patients with comparable BP levels, the prevalence of RH is higher in EH patients, while the incidence of LVH is higher in PA patients and is not related to the presence of RH. In the EH group, RH patients have a higher incidence of LVH than non-RH patients. Office systolic blood pressure, male gender, and diabetes are important predictive factors for RH in PA patients.

Key words: Resistant hypertension, Primary aldosteronism, Essential hypertension

CLC Number:

R586.24
R446

MA Yu, WU Qihong, KANG Yuanyuan, HONG Mona, TANG Xiaofeng, GAO Pingjin, XU Jianzhong, WANG Jiguang. Analysis of clinical characteristics of patients with resistant hypertension in primary aldosteronism[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(04): 449-454.

Figures/Tables 4

Figure 1

Table 1

Clinical characteristics of RH patients in PA and EH groups

Characteristics	PA （n=385）			EH（n=385）
Characteristics	RH (n=51)	Non-RH (n=334)	P	RH (n=136)	Non-RH (n=249)	P
Male/Female	38/13	172/162	0.001	65/51	134/115	0.389
Age（years）	52.2 ± 11.2	50.4 ± 11.0	0.283	54.2± 11.7	46.7 ± 14.5	0.994
BMI (kg/m²)	25.8 ± 3.4	25.0 ± 3.5	0.124	26.0 ± 3.3	25.2 ± 3.3	0.753
Diabetes [n (%)]	17 (33.3)	53 (15.9)	0.004	39 (28.7)	41 (16.5)	0.004
Hypertension duration (years)	12.9 ± 8.3	10.8± 8.5	0.096	13.3 ± 10.8	7.9 ± 8.3	<0.001
FBG (mmol/L)	5.1 ± 1.4	4.8 ± 0.9	0.143	5.0 ± 1.3	4.8 ± 1.1	0.175
Serum creatinine (μmol/L)	70.2 ± 14.7	67.9 ± 16.8	0.296	73.5 ± 16.3	68.6 ± 16.4	0.006
Serum K⁺(mmol/L)	3.3 ± 0.4	3.2 ± 0.4	0.114	3.7 ± 0.4	3.7 ± 0.4	0.972
Triglyceride (mmol/ L)	1.5 ± 1.2	1.1 ± 1.1	0.063	1.6 ± 1.6	1.5 ± 1.2	0.379
Total cholesterol (mmol/ L)	3.8 ± 0.9	4.0 ± 0.9	0.215	4.2 ± 1.0	4.3 ± 0.9	0.974
LDL（mmol/ L）	2.1 ± 0.7	2.2 ± 0.8	0.273	2.4 ± 0.8	2.3 ± 0.8	0.834
HDL（mmol/ L）	0.5 ± 0.5	0.7 ± 0.5	0.004	0.7 ± 0.5	0.7 ± 0.5	0.323
PAC（ng/L）	302.5±191.9	313.1 ± 177.2	0.711	170.7±101.0	176.5 ± 90.7	0.579
PRA [ng/(ml·h)]	0.9± 0.9	0.7 ± 0.8	0.341	2.8± 2.3	2.9 ± 2.2	0.760
Urinary aldosterone (μg/24 h)	19.1 ± 15.4	21.1 ± 14.3	0.415	7.1 ± 4.3	8.7 ± 5.4	0.002
SBP in consulting room（mmHg）	158.3 ± 21.1	145.6 ± 19.5	<0.001	150.6 ± 21.2	146.8 ± 18.2	0.077
DBP in consulting room（mmHg）	91.8 ± 15.4	86.5 ± 12.9	0.023	88.1 ± 16.1	89.6 ± 13.7	0.341
24 h mean SBP（mmHg）	139.5 ± 14.7	135.1 ± 13.3	0.043	137.9 ± 16.4	134.1 ± 14.1	0.025
24 h mean DBP（mmHg）	86.0 ± 11.0	85.5 ± 8.7	0.773	84.4 ± 10.4	85.6 ± 10.2	0.292
Daytime SBP（mmHg）	143.0 ± 14.9	137.5 ± 13.6	0.015	140.9 ± 16.5	138.1 ± 14.6	0.093
Daytime DBP（mmHg）	88.2 ± 11.4	87.3 ± 9.0	0.594	86.5 ± 10.7	88.5 ± 10.7	0.080
Nighttime SBP（mmHg）	132.8 ± 17.1	129.9 ± 15.4	0.253	131.1 ± 19.0	125.4 ± 15.3	0.003
Nighttime DBP (mmHg)	81.6 ± 11.5	81.8 ± 9.6	0.922	79.4 ± 11.7	79.3 ± 10.9	0.892
Log NT-proBNP	1.8 ± 0.5	1.7± 0.4	0.647	1.6 ± 0.5	1.4± 0.4	<0.001

Table 1

Figure 2

Table 2

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Variables	EH (n=385)			PA (n=385)
Variables	β	t	P value	β	t	P value
Age（Years）	0.005	2.339	0.020
LVH	0.186	3.867	<0.001
Hypertension duration (Years)	0.006	2.074	0.039
Serum creatinine (μmol/L)	0.004	2.856	0.005
Systolic pressure (mmHg)				0.003	3.362	<0.001
Male				0.084	2.465	0.014
Diabetes				0.013	2.341	0.020