Scientific publications

Differences in the presentation and evolution of primary aldosteronism in elderly (≥65 years) and young patients ( <65 years)

May 1, 2022 | Magazine: Endocrine Connections

Paola Parra Ramírez  1 , Patricia Martín Rojas-Marcos  2 , Miguel Paja Fano  3 , Marga González Boillos  4 , Eider Pascual-Corrales  5 , Ana García-Cano  6 , Jorge Gabriel Ruiz-Sanchez  7 , Almudena Vicente  8 , Emilia Gomez-Hoyos  9 , Rui Ferreira  10 , Iñigo García Sanz  11 , Mònica Recasens  12 , Begoña Pla Peris  13 , Rebeca Barahona San Millan  14 , María José Picón César  15 , Patricia Díaz Guardiola  16 , Juan Jesús García González  17 , Carolina Perdomo  18 , Laura Manjón  19 , Rogelio Garcia-Centeno  20 , Juan Carlos Percovich  21 , Ángel Rebollo Román  22 , Paola Gracia Gimeno  23 , Cristina Robles Lázaro  24 , Manuel Morales  25 , Felicia Hanzu  26 , Marta Araujo-Castro  27

Objective: To compare the presentation and evolution of primary aldosteronism (PA) in elderly (≥65 years) and young patients (<65 years).

Methods: A retrospective multicenter study performed in 20 Spanish hospitals of PA patients in follow-up between 2018-2021.

Results: 352 patients with PA <65 years and 88 patients ≥65 years were included. Older PA patients had a two-fold higher prevalence of type 2 diabetes, dyslipidemia, and cerebrovascular disease, but these differences disappeared after adjusting by hypertension duration. At diagnosis, diastolic blood pressure was lower than in young patients (83.3±11.54 vs 91.6±14.46 mmHg, P<0.0001). No differences in the rate of overall correctly cannulation (56.5% vs 42.3%, P=0.206) or the diagnosis of unilaterality (76.9% vs 62.5%, P=0.325) in the adrenal venous sampling (AVS) was observed between elderly and young groups. However, there was a lower proportion of PA patients who underwent adrenalectomy in the elderly group than in the younger group (22.7% (n=20) vs 37.5% (n=132), P=0.009). Nevertheless, no differences in the rate of postsurgical biochemical (100% (n=14) vs 92.8% (n=90), P=0.299) and hypertension cure (38.6% (n=51) vs 25.0% (n=5), P=0.239) were observed between both groups.

Conclusion: Older patients with PA have a worse cardiometabolic profile than young patients with PA, that it is related with a longer duration of the hypertension. However, the results of the AVS, and adrenalectomy are similar in both groups. Therefore, the management of elderly patients with PA should be based not only on age, but rather on the overall medical, physical, social, and mental characteristic of the patients.

CITATION  Endocr Connect. 2022 May 1;EC-22-0169.  doi: 10.1530/EC-22-0169