Protocol summary:

Primary aldosteronism (PA) is characterized by excessive secretion of aldosterone from the adrenal gland.  Presence of hyperaldosteronism is associated with a worse outcome with respect to end organ damage especially faster rate of progression of proteinuria and adverse cardiovascular outcomes. PA is often associated impaired glucose tolerance. The contribution of primary aldosteronism to hypertension in patients with diabetes has not been well studied.  The endocrine society guidelines on management of primary aldosteronism emphasize that people with hypertension should undergo screening given the beneficial effect of treatment of PA

The study aims at screening patients with diabetes and hypertension for primary aldosteronism. All patients with type 2 diabetes attending the diabetes OPD at KEM hospital will be screened for hypertension. Patients with diabetes who are already on antihypertensive medications will also be included. Patients who refuse consent, who have serious infections, diabetic ketosis, heart failure or another known cause of secondary hypertension will be excluded. Written informed consent will be taken after ethical clearance. The identity of participants will be kept confidential and will be coded for further analysis.

A total of 1000 patients will be screened by using PAC/DRC ratio as a screening tool. The test involves collection of blood sample after 15 minutes of sitting position. In patients with positive results, further investigations and treatment as is the standard of care will be provided. This may include further repeat testing, confirmatory testing, CT adrenals and AVS if surgical management is planned. Further management either medical or surgical intervention will be offered to the patients according to guidelines.