MON-284 Type 2 Diabetes Mellitus Complicates Management of Hypertension in Patients with Primary Hyperaldosteronism

Abstract Disclosure: O. Ayegbusi: None. A. Karras: None. D. Donkor: None. J. Schmid: None. V. Prakash: None. M. Buhnerkempe: None. A. Hill: None. V. Williams: None. J.M. Flack: None. M.G. Jakoby: None. Primary hyperaldosteronism (PA) is diagnosed in 10-20% of patients with resistant hypertension (HTN) and is associated with other metabolic disorders, including type 2 diabetes mellitus (DM2). Insight into the impact of DM2 on HTN in patients with PA is lacking, and we hypothesized that DM2 reduced the likelihood of achieving adequate blood pressure (BP) control in patients with PA. We performed a retrospective case-control study of adult patients (age ≥ 18 y) with PA and DM2 (N=48) receiving treatment for HTN in our institution’s HTN Clinic and included in our PA Registry. Controls were HTN Clinic and PA Registry patients without DM2 (N=46). Co-primary endpoints were blood pressure (BP) control and therapeutic requirements for BP management. BP control was determined from measurements of systolic (SBP) and diastolic (DBP) BP at the first HTN Clinic visit (baseline) and for the subsequent 12 months, date of adrenalectomy, or last visit, whichever was first. Mean follow up was 254 ± 104 and 279 ± 82 d for cases and controls, respectively (P = 0.2). Therapeutic requirements were determined by the therapeutic intensity score (TIS) for all antihypertensive agents (TIS = [P/M]1 + [P/M]2 + ⋯ [P/M])n), where “P” is the prescribed dose of BP medication and “M” is the FDA approved maximal daily dose. Cases and controls were well matched for characteristics such as age, race, number of clinic visits, categorization of PA, SBP, DBP, and TIS, though cases predictably had higher HbA1c (P < 0.001) and increased use of glycemic medications (P < 0.001) than controls. Cases also had higher BMI than controls (35 ± 7 vs. 33 ± 6, P = 0.046), were more likely to be male (63 vs. 37%, P = 0.013), and had higher rates of coronary artery disease (CAD, P = 0.048), hyperlipidemia (P < 0.001), and chronic kidney disease (CKD, P < 0.001). At the last clinic appointment, mean SBP was higher for cases than controls (141 ± 17 vs. 134 ± 22 mm Hg, P = 0.01), and proportions of patients with SBP < 140 mm Hg (35 vs. 59%, P = 0.024) or < 130 mm Hg (19 vs. 37%, P = 0.049) were lower for cases than controls. Difference in DBP between groups was minimal. TIS for cases and controls was not significantly different, including when stratified by SBP control. There were also no significant differences in BMI, sex, CKD, CAD or hyperlipidemia by degree of BP control. This study identified clinically significant differences in BP control for PA patients with DM2 compared to non-diabetic PA patients, despite similar therapeutic intensities of BP management measured by TIS. Additional investigation is required to determine DM2-related factors that complicate BP management in PA patients. Presentation: Monday, July 14, 2025