Abstract Details

Title Aldosterone Level Predicts Hypertension After ICH in the REDUCE Trial

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 6-013

Objective

The objective of our study is to evaluate potential biomarkers of persistent hypertension (HTN) in patients with intracerebral hemorrhage (ICH).

Background

HTN is a modifiable risk factor for ICH recurrence and affects over 80% of patients with ICH; however, less than 40% of these patients achieve BP control. Hyperaldosteronism may be an underdiagnosed cause of HTN and may serve as a biomarker of persistent HTN in an ICH population.

Design/Methods

The REDUCE trial is an ongoing, multicenter, open-label, randomized clinical trial comparing standard-of-care HTN regimens versus spironolactone-containing regimens in ICH survivors. Baseline electrolytes, aldosterone levels, plasma renin activity, and serial upright BP measurements were obtained prior to randomization. Patients with an average systolic BP ≥ 120 mmHg were randomized. We evaluated whether aldosterone and plasma renin activity could predict persistent HTN in these patients. Low aldosterone was defined as < 2 ng/dL and low plasma renin activity was defined as < 0.7 ng/mL/hr.

Results To date, 33 patients have been enrolled in REDUCE (76% male, average age: 62), of which 76% have been randomized (average BP meds pre-randomization: 3). Patients with low aldosterone (< 2 ng/dL) (n=10) were less likely to have average post-ICH systolic BPs of ≥ 120 mmHg (χ²=9.99, p=0.002). Patients with aldosterone levels ≥ 2 ng/dL (n=23) had an average systolic BP of 135 mmHg while patients with lower aldosterone levels (< 2 ng/dL) (n=10) had an average systolic BP of 118 mmHg (p=0.003). Elevated aldosterone remained strongly associated with systolic BP after controlling for age and gender (OR=16.52, 95%CI (1.94-140.87), p=0.01). Plasma renin activity was not associated with systolic BP (p=0.437).

Conclusions

This preliminary data from the REDUCE trial points to aldosterone as a potential biomarker to predict elevated systolic BP in patients with ICH.

Authors/Disclosures
Julia Zabinska PRESENTER	Ms. Zabinska has nothing to disclose.
Teng J. Peng, MD (University of Florida)	Dr. Peng has nothing to disclose.
Rachel Forman, MD (Yale Neurology)	Dr. Forman has nothing to disclose.
Anna Schwartz	No disclosure on file
Audrey Leasure	Ms. Leasure has nothing to disclose.
Maia Schlechter	Ms. Schlechter has nothing to disclose.
Guido J. Falcone, MD (Yale School of Medicine)	The institution of Dr. Falcone has received research support from NIH. The institution of Dr. Falcone has received research support from AHA.
Adam De Havenon, MD, FAAN (Yale University)	Dr. De Havenon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novo Nordisk. Dr. De Havenon has or had stock in Certus.Dr. De Havenon has or had stock in TitinKM. The institution of Dr. De Havenon has received research support from NIH/NINDS. Dr. De Havenon has received publishing royalties from a publication relating to health care.
Lauren H. Sansing, MD	Dr. Sansing has nothing to disclose.
Dheeraj D. Lalwani (Yale University School of Medicine, Department of Neurology)	Mr. Lalwani has nothing to disclose.
Nethra Parasuram (Yale School of Medicine)	No disclosure on file
Vineetha Yadlapalli (Drexel University College of Medicine)	Miss Yadlapalli has nothing to disclose.
Cheryl Bushnell, MD, MHS (Wake Forest School of Medicine)	The institution of Dr. Bushnell has received research support from PCORI. The institution of Dr. Bushnell has received research support from NIH/NINDS. Dr. Bushnell has received intellectual property interests from a discovery or technology relating to health care. Dr. Bushnell has received publishing royalties from a publication relating to health care.
Michael T. Mullen, MD (Temple University)	Dr. Mullen has received publishing royalties from a publication relating to health care.
Jordana Cohen (University of Pennsylvania)	Jordana Cohen has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Jordana Cohen has received research support from National Institutes of Health. Jordana Cohen has received publishing royalties from a publication relating to health care.
Debbie Cohen	Debbie Cohen has nothing to disclose.
Steven R. Messe, MD, FAHA, FAAN (Hospital of the University of Pennsylvania)	Dr. Messe has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novo Nordisk. Dr. Messe has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Terumo. Dr. Messe has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for WL Gore. The institution of Dr. Messe has received research support from WL Gore. The institution of Dr. Messe has received research support from Mallinkrodt. The institution of Dr. Messe has received research support from Biogen. Dr. Messe has received intellectual property interests from a discovery or technology relating to health care. Dr. Messe has received publishing royalties from a publication relating to health care. Dr. Messe has received personal compensation in the range of $500-$4,999 for serving as a Clinical Event Committee for the CONFORMAL left atrial appendage occlusion trial with Yale Cardiovascular Research Group.
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.

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