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Moderate dietary salt restriction reduces BP in primary aldosteronism

14th April 2023

A moderate dietary reduction of salt intake gives rise to a significant reduction in blood pressure in those with primary aldosteronism

German researchers have observed significant reduction in blood pressure (BP) following a moderate dietary reduction of salt intake in patients with primary aldosteronism.

The link between intake of sodium (in the form of salt) and hypertension is widely recognised such that reducing dietary intake not only lowers BP but is also associated with a reduction in morbidity and mortality from cardiovascular diseases. The presence of primary aldosteronism (PA) is a common cause of secondary hypertension and associated with excess cardiovascular morbidities. In fact, having PA is associated with more end-organ damage and an excess cardiovascular morbidity, including heart failure, stroke, nonfatal myocardial infarction, and atrial fibrillation compared to primary hypertension. An unfortunate consequence for patients with PA is a decreased taste sensitivity for salt, favouring high sodium consumption. Given this relationship, the German researchers wondered if a moderate dietary reduction in salt in patients with PA could reduce blood pressure.

Researchers identified a group of PA patients already under treatment with anti-hypertensives from a national registry. Individuals were recruited for a dietary salt restriction over 12 weeks with structured nutritional training and consolidation by a mobile health app. Salt intake and adherence were monitored every 4 weeks using 24-h urinary sodium excretion.

Moderate dietary salt reduction and blood pressure

A total of 41 participants with a mean age of 50 years (52.2% female) were included in the analysis.

At the end of the study, dietary salt intake which was originally estimated from urinary excretion to be 9.1 g/day, fell to 5.2 g/day (p < 0.001). In addition, systolic blood pressure reduced from 130 at baseline to to 121 mm Hg (p < 0.001) and diastolic blood pressure from 84 to 81 mm Hg (p = 0.003).

In addition, participants noted a significant weight loss of 1.4 kg (p < 0.001), largely due to water loss and an improvement in pulse pressure, an indicator of arterial stiffness (p < 0.001). Interestingly, there were also improvements in depression scores (p = 0.008).

The authors concluded that moderate dietary salt restriction intake in patients with PA substantially reduces BP and depressive symptoms.

Schneider H et al. Moderate dietary salt restriction improves blood pressure and mental well-being in patients with primary aldosteronism: The salt CONNtrol trial. J Intern Med 2023

Metomidate scan enables diagnosis of primary aldosteronism

21st January 2023

Metomidate computed tomography scanning was able to successfully identify primary aldosteronism and was non-inferior to adrenal vein sampling

Metomidate used as a PET radiotracer and in combination with high resolution computed tomography (CT) has been shown to be non-inferior to adrenal vein sampling (AVS), as a non-invasive means of detecting primary aldosteronism according to a study by a team of UK researchers.

Primary aldosteronism (PA) has been shown to be responsible for 5.9% of cases of hypertension and this figure increased to 11.8% in patients with stage 3 hypertension. PA can be surgically corrected when caused by unilateral aldosterone hyper-secretion for which the usual cause is an aldosterone-producing adenoma. Moreover, hypertension due to PA has a worse prognosis compared with blood pressure-matched essential hypertension. The use of AVS is recognised as the most reliable means of identifying whether aldosterone production is uni- or bilateral. Nevertheless, an alternative is the use of imaging modality, such as metomidate positron emission tomography computed tomography (MTO) and which, in one small study has been shown to both a sensitive and specific alternative to adrenal vein sampling. Nevertheless, with a limited evidence base to demonstrate the value of this imaging modality, in the present study, researchers set out to compare the accuracy of MTO and AVS at predicting the outcome following adrenalectomy in patients with PA and ultimately resolution of hypertension in these patients. Individuals with confirmed PA underwent both MTO and AVS and were commenced on spironolactone 50mg but which was increased to 100mg after two weeks. Both techniques were used to assess the probability of unilateral PA and where this was high, unilateral adrenalectomy was recommended, or medical management where it was not detected.

Metomidate scanning and the outcome following adrenalectomy

A total of 128 patients with a median age of 52 years (68% male) were included in the study.

The use of MTO graded 52% of patients with a high probability of unilateral PA compared with 45% following AVS, although overall, 67% of the entire cohort were scored as having a high probability of unilateral PA.

Following surgery, the accuracy of MTO at predicting clinical success was 65.4% compared to 61.5% for AVS. These differences did not reach the predefined inferiority statistical margin; in other words, MTO was not inferior to AVS. Only 23 of 78 patients undergoing surgery achieved blood pressure readings of below 135/85mmHg, although 12 individuals were able to stop antihypertensive treatment.

There were a total of 24 serious adverse events although none of these were considered to be related to the procedures, and 22 fully resolved.

The authors concluded that MTO was an effective non-invasive means to diagnose unilateral PA and could be used as an alternative to AVS.

Wu X et al. [11C]metomidate PET-CT versus adrenal vein sampling for diagnosing surgically curable primary aldosteronism: a prospective, within-patient trial. Nat Med 2023