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