FRI127 Delay Of A Decade In The Diagnosis Of Primary Aldosteronism In Patients With Onset Of Hypertension ≤ 40 Yo
Authors: Parisien-La Salle Stefanie , Lacroix André , Bourdeau Isabelle 
Published: October 2023

Abstract
Disclosure: S. Parisien-La Salle: None. A. Lacroix: None. I. Bourdeau: None.
Introduction: Primary aldosteronism (PA) is a frequent and underdiagnosed cause of secondary hypertension. Mean age at diagnosis is 50-55 years old (yo), however, hypertension often precedes the diagnosis of PA by many years [1,2]. Objective: To evaluate the delay between the diagnosis of hypertension and the diagnosis of PA in patients with onset of hypertension ≤ 40 yo. Methods: We retrospectively collected the clinical information of patients with PA who were diagnosed with hypertension at ≤ 40 yo from our specialized genetics adrenal clinic. Results: We identified 47 patients with PA who presented with hypertension at ≤ 40 yo. Twenty-one patients (44.7%) were female. At diagnosis of PA, 76.6% (36/47) had hypokalemia, 29.8% (14/47) had sleep apnea, 17% (8/47) had type 2 diabetes, 8.5% (4/47) had coronary artery disease and 4.3% (2/47) had atrial fibrillation. More than half of patients (53.2%) were on 3 or more anti-hypertensive drugs. Mean age at diagnosis of hypertension was 30.8 and mean age at diagnosis of PA was 43.5 yo with an average delay of 12.7 years and a median delay of 10 years (IQR: 4,10,19,37).In the group diagnosed with PA within 10 years of the diagnosis of hypertension (n: 24), the average number of anti-hypertensive drugs per patient was 2.3 and 79.2% (19/24) had hypokalemia. In the group diagnosed with PA more than 10 years after the diagnosis of hypertension (n: 23), the average number of anti-hypertensive drugs per patient was higher at 3.4 with a similar prevalence of hypokalemia (73.9% (17/23)).In patients with hypertension diagnosed ≤ 30 yo (n: 23), the mean age at diagnosis of hypertension was 25.3 yo with a median of 28, and the mean age at diagnosis of PA was of 39.2 yo with a median of 34. Thus, the average delay was 13.9 years and the median was 10 years (IQR: 1.5, 10, 26.5, 37). However, in patients with hypertension diagnosed ≤ 20 yo (n: 5), the mean age at diagnosis of hypertension was 16.8 yo with a median of 18, and the mean age at diagnosis of PA was of 25.4 yo with a median of 21 yo. Thus, the average delay was 8.6 years and the median was 3 years (IQR: 2,3,10,28). Conclusion: We demonstrate that in our cohort the median delay is approximately of 10 years between the diagnosis of hypertension and PA for patients diagnosed with hypertension between 30 and 40 yo. Neither the number of antihypertensive drugs, nor the presence of hypokalemia seemed to determine a shorter delay of diagnosis. However, patients diagnosed with hypertension ≤ 20 yo had shorter delays of diagnosis of PA with a median of 3 years. Bibliography: 1. Alam, S.; Kandasamy, D.; et al. High prevalence and a long delay in the diagnosis of primary aldosteronism among patients with young-onset hypertension. Clin Endocrinol (Oxf)2021, 94, 895-903, doi:10.1111/cen.14409.2. Turcu, A.F.; Yang, J.; Vaidya, A. Primary aldosteronism - a multidimensional syndrome. Nat Rev Endocrinol2022, 18, 665-682, doi:10.1038/s41574-022-00730-2.
Presentation: Friday, June 16, 2023