Keming Zhou

Genetic Variations in the KCNJ5 Gene in Primary Aldosteronism Patients from Xinjiang, China

Background Primary aldosteronism (PA) is the most common endocrine form of secondary hypertension, and one of the most common subtypes of sporadic PA is aldosterone-producing adenoma (APA). Recently, two somatic mutations of the KCNJ5 gene were implicated in APA, and two germline mutations were associated with familial hyperaldosteronism III. Objectives This case-control study was designed to investigate the relationship between genetic variations in the KCNJ5 gene and sporadic PA patients in Xinjiang, China. Methods Five common single nucleotide polymorphisms (SNPs) of the KCNJ5 gene (rs6590357, rs4937391, rs3740835, rs2604204, and rs11221497) were detected in patients with sporadic PA (n = 235) and essential hypertension (EH; n = 913) by the TaqMan polymerase chain reaction method. Results The EH group and the PA group showed significant differences in the distributions of genotypes and alleles of rs4937391 and rs2604204 in total and male subjects (P<0.05), as well as rs3740835 in male subjects (P<0.05). However, only the association between the rs2604204 genotype and male sporadic PA remained significant after Bonferroni’s correction (P<0.01). Furthermore, logistic regression analysis demonstrated that the CC genotype of rs2604204 was a risk factor for male patients with sporadic PA, after adjusting for age and body mass index (odds ratio = 2.228, 95% CI: 1.300–3.819, P = 0.004). Conclusion The genetic variant rs2604204 of KCNJ5 is associated with sporadic PA in Chinese males, suggesting that KCNJ5 may be involved in the pathogenesis of sporadic PA in these particular patients.

Prevalence of Primary Aldosteronism in Hypertensive Subjects with Hyperglycemia

The aim of this study was to examine the prevalence of primary aldosteronism (PA) in hypertensive patients with hyperglycemia. Two hundred and thirty-two hypertensive patients with hyperglycemia were screened for PA. Fifty-four subjects with an aldosterone/rennin activity ratio >20 ng/dL per ng/mL/hour underwent a saline loading test. Primary aldosteronism was present in 22.4% of patients with a plasma aldosterone concentration >5 ng/dL and 11.6% of those with plasma aldosterone concentrations >10 ng/dL. There were 14.0%–23.0% patients with PA in the diabetes mellitus group, 2.3%–23.3% in the impaired glucose tolerance group, and 9.1% in the impaired fasting glucose group. Primary aldosteronism is common in hypertensive individuals with hyperglycemia.

Plasma Aldosterone Concentration Is Positively Associated With Pulse Pressure in Patients With Primary Hypertension

AbstractIncreasing evidence showed a link between arterial elasticity and stiffness and pulse pressure (PP), in which plasma aldosterone may play a role. The observational study aimed to explore the potential relations between plasma aldosterone concentration (PAC) and PP in patients with hypertension.We evaluated the relation between PP and PAC in supine, seated, and upright positions in 195 patients with primary hypertension who underwent postural stimulation test. They were divided into 3 groups by tertiles of PP: PP ⩽ 44 mm Hg (n = 70), 44 mm Hg < PP ⩽ 51 mm Hg (n = 63), and PP ≥ 51 mm Hg (n = 62). The PAC in different postures was compared, respectively.The results showed the following. First, segregated by tertiles of PP, serum K+, 24-hour systolic blood pressure, 24-hour diastolic blood pressure, sex, upright PAC, and seated PAC showed statistically significant differences in groups. Second, the PAC were significantly different in 3 levels of PP regardless of postures, the individuals with PP ≥ 51 mm Hg had the highest PAC. On contrast, the patients with PAC > 12 ng/dL showed greater PP than those with PAC ⩽ 12 ng/dL. Third, weak associations between PP and upright (r = 0.288, P < 0.001), seated (r = 0.265, P < 0.001), and supine postures (r = 0.191, P = 0.008) were detected by simple correlation analysis. After corrected serum K+, age, and sex, the partial correlation coefficients did not change greatly. Fourth, the logistic regression model was constructed with PP ≥ 40 mm Hg or PP < 40 mm Hg as the dependent variable; the serum K+[OR = 0.043, 95% CI: 1.09(1.00–1.12)] and PAC [OR = 0.025, 95%CI: 0.35(0.13–0.88)] were included as significant contributing factors.The results showed that higher PAC was weakly, but significantly, correlated to greater PP regardless of different postures, suggesting that higher PAC may be a risk factor of reduced arterial elasticity in patients with hypertension.

OS 22-08 Prevalence of primary aldosteronism and its cardio-metabolic factors Chinese hypertensive patients in Xinjiang of China.

Objective: To investigated the prevalence of primary aldosteronism (PA) and compare the pattern of PA patients with essential hypertension regarding clinical data in general hypertensive patients in Xinjiang of China. Design and Method: Consecutive hypertensive patients referred to Hypertension Center of Xinjiang from 2009 to 2011 underwent a diagnostic protocol composed of measurement of Na+ and K+ in serum and 24-h urine, sitting plasma renin activity, and aldosterone at baseline and after saline loading test. The patients with an aldosterone/renin ratio >20 at baseline, and/or >5 after saline loading test, and adrenal vein sampling (AVS). Patients were evaluated for glucose, lipid profile, smoking and alcoholism and the clinical profiles were compared between PA and HBP group. Results: (1) 474 (28.03%) out of 1677 hypertensive patients were diagnosed PA. (2) 25.4% females with hypertension were identified PA, the detection rate of PA was around 30% in OSAS, obese, age<45 yr and hyperglycemia population, respectively. (3) The patients of PA showed worse blood control, lower serum K+(3.72 ± 0.38mmol/L), higher urine K+ excretion (42.68 ± 16.62 mmol/L) compared to HBP. 197 (43.2%) were obese in PA patients with a mean BMI of 27.43 ± 3.67 kg/m2 and 416 (35.6%) were obese with a mean BMI of 26.87 ± 3.77 kg/m2 in HBP group, but the fasting glucose, TC and LDL-C showed higher levels in patients with HBP. 43.2% PA patients and 35.6% HBP patients were diagnosed of OSAS (AHI > 5). (4) Multivariate logistic regression analysis showed that abnormal presence of adrenal CT, hypokalemia history, family history of hypertension and severity of OSAS would increase the risk of PA. Conclusions: A markedly prevalence of PA (28.03%) was detected in Chinese general hypertensive population, the greater detection rate of PA in males and patients with severe OSAS leading to a concept that PA identification should extend to such individuals.

639 THE EVALUATION AND ANALSIS OF RENIN LEVEL IN PATIENTS WITH PHEOCHROMOCYTOMA

Objective: To evaluate and analyze the levels of serum renin in patients with pheochromocytoma and essential hypertension. Methods: We respectively analyzed the clinic data of inpatients in our department from 1997 to 2004. Matched for gender and nation, the patients with confirmed essential hypertension during the same period were selected as controls. These selected subjects should meet the following criteria: the patients with PHEO were diagnosed by operation and pathology. The patients with EH followed criteria (1) systolic blood pressure≥140mmHg or diastolic blood pressure≥90 mmHg (2) free of secondary hypertension. The menstruation of renin: patients lay flatly over 7 hours at night. Blood samples were obtained by venipuncture at 8 Am the next morning, which stored frozenly at 4 °C. The levels of serum renin were measured. The difference between two groups was compared by t test. Results: (1) No significant difference was observed in the gender, nation, age between PHEO and EH group. (2) The mean level of renin in PHEO: 2.54 ± 3.30 ng/ml/h, and that of EH: 1.86 ± 2.42 ng/ml/h. No significant difference was detected between PHEO and EH group (P > 0.05). Conclusion: There is no significant difference of the renin in patients with pheochromocytoma and essential hypertension.

637 PREVALENCE OF PRIMARY ALDOSTERONISM IN HYPERTENSIVE SUBJECTS WITH HYPERGLYCEMIA

Background: Recent studies have reported higher prevalence of primary aldosteronism (PA) than ever before in patients with hypertensive, and hyperglycemia is common in hypertensivers. It is unknown, however, the prevalence of PA in hypertensive patients with glucose disorders (including hyperglycemia, known diabetes mellitus (DM), impaired glucose tolerant (IGT) and impaired fasting glucose (IFG). The aim of this study was to examine the prevalence of PA in this special group. Method: A total of 232 adult subjects with hypertension and hyperglycemia were screened for PA. Subjects with a plasma aldosterone concentration to plasma rennin activity ratio (ARR) above 20 underwent confirmatory saline loading testing which is as confirmative test for PA. Results: 66 subjects (28.4%) had an ARR above 20 (ng/dl per ng/ml/h), of which 54 subjects with suspected PA were performed saline loading testing. PA was present in 22.4% (plasma aldosterone concentration >5ng/dl) and in 11.6% in total subjects (plasma aldosterone concentration >10ng/dl in total subjects). And it were at least 14.0∼23.0% in the DM group, 2.3∼23.3% in the IGT group, and 9.1% in the IFG group, respectively. Conclusion: PA is common in patients with hypertensive complicated with hyperglycemia. Chinese Significant numbers of hypertensive individuals with hyperglycemia may be subclinical forms of PA, and these special subjects should be screened for primary aldosteronism.

635 ANALYSIS OF CLINICAL CHARACTERISTICS OF 11 CASES OF PARAGANGLIOMA

Background: Clinical manifestation of extra-adrenal Pheochromocytoma is complex, involving multiple systems and organ. In addition to episodes of hypertension, headache, sweating, palpitation, some patients due to the lack of specificity of the symptoms, signs, often lead to misdiagnosis. Methods: 11cases of paraganglioma confirmed by pathology in Xin Jiang Autonomous Region people hospital from 1998 to 2008 were retrospectively analyzed. Results: For any of the following symptoms and no adrenal abnormalities in the population should pay attention to the possible extra-adrenal pheochromocytoma: (1) No cause for the malignant hypertension; (2) Strenuous activity, changes in body posture and activity induced hypertension; (3) On the general antihypertensive drugs ineffective In patients with hypertension; (4) appearance of no explaining the high blood pressure or shock during operation. Especially the younger without a clear family history of hypertension, if the clinical history check to transient hypertension evidence, it should be further examined. Conclusion: The measurement of Serum, urinary VMA were same valuable for diagnosis between paraganglioma and adrenal pheochromocytoma,tumor localization was difficult, paraganglioma can occur in any part of the body. The majority of them is located in abdomen, the most common site for para-aortic, near the renal hilum, the inferior vena cava. But most paraganglioma can be diagnosed by B ultrasonography, CT, MRI, 131I-MIBG. The surgical ablation thoroughly was the best choice to cure extra-adrenal pheochromocytoma.