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Cardiovascular medicine
Original research
Risky business: a single-centre cross-sectional analysis of calculated cardiovascular risk in patients with primary aldosteronism and essential hypertension
  1. Pravik Solanki1,2,
  2. Stella May Gwini3,4,
  3. Renata Libianto1,2,5,
  4. Genevieve Gabb6,7,
  5. Jimmy Shen1,5,
  6. Morag J Young8,9,
  7. Peter J Fuller1,5,
  8. Jun Yang1,2,5
  1. 1Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
  2. 2Department of Medicine, Monash University, Clayton, Victoria, Australia
  3. 3University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
  4. 4School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  5. 5Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
  6. 6School of Medicine, Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia
  7. 7College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
  8. 8Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
  9. 9Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Pravik Solanki; pravik.solanki{at}gmail.com

Abstract

Objectives Primary aldosteronism (PA), the most common endocrine cause of hypertension, is associated with a higher risk of cardiovascular disease (CVD) than blood pressure (BP)-matched essential hypertension (EH). We aimed to compare the calculated risks of CVD in patients who had hypertension with PA or EH using CVD risk calculators, hypothesising that they will fail to recognise the increased CVD risk in PA.

Design Cross-sectional analysis.

Setting An endocrine hypertension service in Victoria, Australia.

Participants Patients who had hypertension without CVD referred for the investigation of hypertension.

Outcome measures Calculated 5-year or 10-year CVD risk as predicted by the National Vascular Disease Prevention Alliance (NVDPA) algorithm, Framingham Risk Score, Pooled Cohort Equations and QRISK3.

Results Those with PA (n=128) and EH (n=133), did not differ significantly in their calculated CVD risks with the NVDPA algorithm (moderate-to-high 5-year risk 36/100 vs 45/99, p=0.17); the Framingham Risk Score (median 10-year risk 7.72% (4.43%–12.95%) vs 6.84% (3.85%–10.50%), p=0.14); the Pooled Cohort Equations (median 10-year risk 9.45% (4.36%–15.37%) vs 7.90% (2.09%–14.73%), p=0.07); and QRISK3 (median 10-year risk 11.31% (7.22%–20.29%) vs 12.47% (5.10%–19.93%), p=0.51). Similarities persisted on regression analyses accounting for systolic BP.

Conclusions CVD risk algorithms do not reflect the increased risk of CVD in patients with PA, and likely underestimate the true risk of CVD among those with PA. Screening for PA, in addition to using the CVD risk algorithm in patients who had hypertension, may facilitate the targeted treatment of PA and minimisation of cardiovascular risk in affected individuals.

  • hypertension
  • adrenal disorders
  • public health

Data availability statement

No data are available.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2022-062406

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    Data availability statement

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    Footnotes

    • Twitter @praviksolanki, @DrJunYang

    • Contributors PS conducted literature review, data collection, data analysis and drafted the manuscript. He is a guarantor. SG assisted in conducting data analysis, and reviewed and edited the manuscript. RL designed data collection tools, conducted data collection and reviewed and edited the manuscript. GG was involved in study conception, data interpretation and reviewing and editing the manuscript. JS, MJY and PJF assisted in data interpretation, and reviewed and edited the manuscript. JY was involved in study conception, literature review, data interpretation and reviewing and editing the manuscript.

    • Funding JY is supported by an NHMRC Investigator Grant (APP1194576).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.