Approach to the Patient on Antihypertensive Therapy: Screen for Primary Aldosteronism

Mulatero, Paolo; Bertello, Chiara; Veglio, Franco; Monticone, Silvia

doi:10.1210/clinem/dgac460

Cited by 20 publications

(6 citation statements)

References 55 publications

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“…Further, highly elevated levels of progesterone in pregnancy may promote aldosterone production independently from the renin-angiotensin system [52] or even interfere with aldosterone signaling through the mineralocorticoid receptor [53]. Results from a recent trial, treatment for mild chronic hypertension during pregnancy, underscore the important of blood pressure control in pregnancy for the prevention of adverse outcomes [54], and patients with hypertension in our study were treated with labetalol (a beta blocker) or nifedipine (a calcium channel blocker in the dihydropyridine class), where the former can decrease and the latter can increase plasma renin activity [55], potentially confounding interpretation of RAAS in pregnancy. Likewise, the ratio of uric acid to creatinine in serum is associated with the development of pre-eclampsia [56].…”

Section: Discussionmentioning

confidence: 80%

Association of Elevated Serum Aldosterone Concentrations in Pregnancy with Hypertension

Shoemaker,

Poglitsch,

Davis

et al. 2023

Biomedicines

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Emerging evidence indicates a previously unrecognized, clinically relevant spectrum of abnormal aldosterone secretion associated with hypertension severity. It is not known whether excess aldosterone secretion contributes to hypertension during pregnancy. We quantified aldosterone concentrations and angiotensin peptides in serum (using liquid chromatography with tandem mass spectrometry) in a cohort of 128 pregnant women recruited from a high-risk obstetrics clinic and followed prospectively for the development of gestational hypertension, pre-eclampsia, superimposed pre-eclampsia, chronic hypertension, or remaining normotensive. The cohort was grouped by quartile of aldosterone concentration in serum measured in the first trimester, and blood pressure, angiotensin peptides, and hypertension outcomes compared across the four quartiles. Blood pressures and body mass index were greatest in the top and bottom quartiles, with the top quartile having the highest blood pressure throughout pregnancy. Further stratification of the top quartile based on increasing (13 patients) or decreasing (19 patients) renin activity over gestation revealed that the latter group was characterized by the highest prevalence of chronic hypertension, use of anti-hypertensive agents, pre-term birth, and intrauterine growth restriction. Serum aldosterone concentrations greater than 704 pmol/L, the 75th percentile defined within the cohort, were evident across all categories of hypertension in pregnancy, including normotensive. These findings suggest that aldosterone excess may underlie the development of hypertension in pregnancy in a significant subpopulation of individuals.

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Section: Discussionmentioning

confidence: 80%

Association of Elevated Serum Aldosterone Concentrations in Pregnancy with Hypertension

Shoemaker,

Poglitsch,

Davis

et al. 2023

Biomedicines

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“…Finally, measurements of aldosterone and renin were not standardized and may have been affected by actual medication. However, there is a growing consensus among PA experts that discontinuing antihypertensive drugs before the initial PA screening is not necessary [ 40 , 41 ]. In our study, most patients were using angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, which may have led to a falsely low ARR, possibly resulting in an underestimation of the true prevalence of elevated ARR [ 39 , 40 ].…”

Section: Study Limitationsmentioning

confidence: 99%

Gender Differences in Cardiac Organ Damage in Arterial Hypertension: Assessing the Role of Drug Nonadherence

Aune,

Ohldieck,

Halvorsen

et al. 2024

High Blood Press Cardiovasc Prev

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Introduction Cardiac organ damage like left ventricular (LV) hypertrophy and left atrial (LA) enlargement is more prevalent in women than men with hypertension, but the mechanisms underlying this gender difference remain unclear. Methods We tested the association of drug nonadherence with the presence of LV hypertrophy and LA enlargement by echocardiography in 186 women and 337 men with uncontrolled hypertension defined as daytime systolic blood pressure (BP) ≥ 135mmHg despite the prescription of at least two antihypertensive drugs. Drug adherence was assessed by measurements of serum drug concentrations interpreted by an experienced pharmacologist. Aldosterone-renin-ratio (ARR) was measured on actual medication. Results Women had a higher prevalence of LV hypertrophy (46% vs. 33%) and LA enlargement (79% vs 65%, both p < 0.05) than men, while drug nonadherence (8% vs. 9%, p > 0.514) did not differ. Women were older and had lower serum renin concentration and higher ARR than men, while 24-h systolic BP (141 ± 9 mmHg vs. 142 ± 9 mmHg), and the prevalences of obesity (43% vs. 50%) did not differ (all p > 0.10). In multivariable analyses, female gender was independently associated with a two-fold increased risk of LV hypertrophy (OR 2.01[95% CI 1.30–3.10], p = 0.002) and LA enlargement (OR 1.90 [95% CI 1.17–3.10], p = 0.010), while no association with drug nonadherence was found. Higher ARR was independently associated with LV hypertrophy in men only (OR 2.12 [95% CI 1.12–4.00] p = 0.02). Conclusions Among patients with uncontrolled hypertension , the higher prevalence of LV hypertrophy and LA enlargement in women was not explained by differences in drug nonadherence. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03209154. Supplementary Information The online version contains supplementary material available at 10.1007/s40292-024-00632-6.

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“…Caution must be taken around hypokalaemia or prescribed antihypertensive medication that can interfere with an accurate ARR interpretation. 6 To ensure the validity of ARR, hypokalaemia should be rectified to minimise false negative results. Mineralocorticoid receptor antagonists (eg spironolactone, eplerenone, amiloride) should be withdrawn for 4 weeks before ARR testing.…”

Section: Mineralocorticoid Excessmentioning

confidence: 99%

Investigation and assessment of adrenal incidentalomas

Cuthbertson

Alam

Davison³

et al. 2023

Clinical Medicine

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With the increasing volume of diagnostic imaging undertaken in an ageing population, adrenal incidentalomas (AIs) are increasingly commonly seen. These masses are most likely to be benign, but a small proportion may be malignant. Similarly, they are usually non-functional, but ∼14% are functional, ie hormone-secreting tumours. Clinical, biochemical and radiological assessment is mandated to stratify patients into those requiring radiological surveillance, medical management or surgical intervention or who can be discharged. Mass characteristics on cross-sectional (CT/ MRI) imaging influence the need for radiological surveillance. Functional tumours where excess cortisol, aldosterone or catecholamine are secreted should be excluded, with mild autonomous cortisol secretion (MACS) and primary aldosteronism (PA) as the two most common functional states. MACS and PA are associated with an increased risk of cardiometabolic disease (eg hypertension, type 2 diabetes) and cardiovascular morbidity/mortality (eg coronary heart disease). Multidisciplinary management is critical for selected cases; the majority of adrenal incidentalomas only require a single assessment.

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Approach to the Patient on Antihypertensive Therapy: Screen for Primary Aldosteronism

Cited by 20 publications

References 55 publications

Association of Elevated Serum Aldosterone Concentrations in Pregnancy with Hypertension

Association of Elevated Serum Aldosterone Concentrations in Pregnancy with Hypertension

Gender Differences in Cardiac Organ Damage in Arterial Hypertension: Assessing the Role of Drug Nonadherence

Investigation and assessment of adrenal incidentalomas

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