Risky business: calculated cardiovascular risk underestimates real risk in hypertensive patients with primary aldosteronism (#352)

Pravik Solanki ¹ ² , Renata Libianto ¹ ² ³ , Genevieve Gabb ⁴ ⁵ , Stella Gwini ⁶ ⁷ , Jimmy Shen ¹ ³ , Morag J Young ⁸ ⁹ , Peter J Fuller ¹ ³ , Jun Yang ¹ ² ³

Department of Endocrinology, Monash Health, Clayton, Victoria
Department of Medicine, Monash University, Clayton, Victoria
Centre for Endocrinology and Metabolism, Hudson Institute, Melbourne, Victoria
School of Medicine, Faculty of Health Science, University of Adelaide, Adelaide, South Australia
College of Medicine and Public Health, Flinders University, Bedford Park, South Australia
Barwon Health, University Hospital Geelong, Geelong, Victoria
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
Cardiovascular Endocrinology Laboratory, Baker Heart & Diabetes Institute, Melbourne, Victoria
Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria

Introduction

In Australia, one’s 5-year risk of developing cardiovascular disease (CVD) is predicted using the National Vascular Disease Prevention Alliance (NVDPA) CVD risk algorithm. However, the risk calculator does not consider Primary Aldosteronism (PA) – a treatable syndrome accounting for 5-10% of hypertension in primary care – despite PA conferring a higher risk of coronary artery disease, atrial fibrillation and stroke than blood pressure (BP)-matched Essential Hypertension (EH). We hypothesise that the NVDPA algorithm fails to capture the additional CVD risk associated with PA.

Methods

The NVDPA CVD risk algorithm was retrospectively applied to patients with sufficient data attending an Endocrine Hypertension Service over 4 years. CVD risk scores of PA and EH patients were compared using Chi-square tests and multivariable logistic regression.

Results

Of 109 patients (66 PA, 43 EH; mean age 54 years; 44% female), those with PA had higher systolic BP than patients with EH (median 148 vs 138mmHg, p=0.021). Calculated 5-year CVD risk was low (<10%) in 70% (n=46) of patients with PA and 79% (n=34) of those with EH, and moderate-to-high in 30% (n=20) of patients with PA and 21% (n=9) of those with EH (p=0.279). After accounting for systolic BP, having PA had no significant association with moderate-to-high CVD risk classification (aOR 1.45, 95% CI 0.29, 8.65).

Discussion

In our cohort, the majority of patients with PA were classified as having low 5-year CVD risk. After accounting for differences in BP, they were not more likely to be classified as having moderate-to-high CVD risk compared to those with EH, despite their worse BP-matched prognosis as identified in recent literature.

Conclusion