[An abdominal CT scan in first-line is an efficient investigation of uncontrolled hypertensives suspected to have an adrenal cause]

Abstract

The prevalence of hypertension resistant to treatment to indicate for renal denervation.

Objective: To evaluate the efficiency for imaging the adrenal glands with an abdominal CT scan in first-line in subjects with resistant hypertension suspected to have an adrenal cause.

Methods: On 75 hypertensive patients uncontrolled by at least a combination therapy, but suspected to have secondary hypertension due to adrenal cause, an abdominal CT scan was performed in first intention. In all subjects, an exploration of the renin-aldosteron axis in standardized conditions, a 24-hour urinary cortisol and a WHO recommended biological analysis were also performed.

Results: An abnormal morphology of adrenal was found by abdominal CT in 64% of patients. The abnormalities observed were: bilateral hyperplasia (27%), unilateral adenoma (15%), unilateral hyperplasia (15%), bilateral adenoma (7%). Abnormal biological and/or hormonal tests for adrenal disease were found in 29% of patients, with a primary aldosteronism (A/R corrected>23) in 11% or K less than 3.5mmol/L in 20%. According to the assessment conducted in first-line, indication to spironolactone is selected in 48% of patients investigated with CT as first-line and in 17% of patients investigated with biological tests (P<0.01) while the indication to adrenal surgery would be held in 15% and 11% of patients respectively.

Conclusion: In a population of subjects with uncontrolled hypertension in which an adrenal cause is suspected, achieving a first-line abdominal CT leads to adrenal abnormality observed in 64% of patients while a specific biological abnormality is noted in 29% of subjects. This study shows that assessment that starts with an abdominal CT scan allows to indicate treatment with spironolactone more frequently than when the first assessment is limited to a biological investigation.