Cardiovascular complications during medication adjustment for the diagnosis of primary aldosteronism

Background: The Endocrine Society Clinical Practice guideline recommends to adjust the antihypertensive medication into a regimen that does not affect the levels of of plasma aldosterone and renin when testing for PA. However, changing the antihypertensive medication may not be without risk.

Objective: To assess the rate of cardiovascular complications during medication adjustment in the diagnostic work-up of patients suspected for having primary aldosteronism (PA)

Methods: In this retrospective study, we evaluated 95 out of 100 consecutive patients with suspected PA or confirmed PA. All patients were scheduled for biochemical testing to confirm or exclude PA. In 72 patients the antihypertensive medication was changed and it was temporarily stopped in 8 patients. We recorded self-reported effects and cardiovascular complications.

Results: Fourteen patients experienced subjective effects while another 5 patients developed cardiovascular non-fatal complications: stroke (n = 3), TIA (n = 1), heart failure (n = 1). In all 5 patients the medication had been changed. It was not possible to demonstrate unequivocally that these complications were related to changes in blood pressure due to medication adjustment. Four of these 5 patients were already known with pre-existent cardiovascular co-morbidity. In 4 of these 5 patients the diagnosis of PA could be confirmed.

Conclusions: In this series of 80 consecutive patients who underwent adjustment of antihypertensive medication for biochemical testing for PA, 6,3% experienced a serious non-fatal cardiovascular complication. Since most of these patients had pre-existing cardiovascular disease, adjustment of antihypertensive medication for biochemical testing should be carefully considered in such patients.