High prevalence of primary aldosteronism in the Tayside hypertension clinic population

Lim, Pitt; Dow, Ellie; Brennan, Geraldine; Jung, R. T.; MacDonald, Thomas M.

doi:10.1038/sj.jhh.1001013

Cited by 248 publications

(139 citation statements)

References 23 publications

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“…Since these earlier studies by Gordon, multiple investigators worldwide have confirmed a prevalence of primary aldosteronism of 5 to 15% in general or selected hypertensive populations (12)(13)(14)(15)(16)(17)(18)(19)(20). Two of these studies are particularly noteworthy because of their scientific rigor and because of the clinical implications of the results.…”

Section: Hypertension and Primary Aldosteronismmentioning

confidence: 93%

Aldosteronism and Hypertension

Calhoun¹

2006

Clinical Journal of the American Society of Nephrology

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A growing body of evidence suggests that hyperaldosteronism contributes significantly to the development and the severity of hypertension as well as to resistance to antihypertensive treatment. In cross-sectional analyses, plasma aldosterone levels have been shown to relate to BP levels, particularly in obese individuals. In these same individuals, BP was not related to plasma renin activity, suggesting an effect of aldosterone on BP independent of renin-angiotensin II. In a recent prospective analysis from the Framingham investigators, baseline serum aldosterone was strongly associated with development of hypertension during a 4-yr follow-up.Clin J Am Soc Nephrol 1: 1039 -1045 , 2006 . doi: 10.2215 H istorically, primary aldosteronism has been thought to be an uncommon cause of hypertension. Recent studies, however, suggest that 10 to 15% of individuals with hypertension fulfill the biochemical criteria for primary aldosteronism. Demonstration of such a high prevalence of primary aldosteronism in patients with presumed primary hypertension suggests that aldosterone excess is a common contributing cause to the development of hypertension.Primary aldosteronism is particularly common in patients with resistant hypertension, with prevalence of approximately 20%. An important role of hyperaldosteronism in contributing to the development of treatment resistance is suggested further by the broad antihypertensive benefit of aldosterone antagonists as add-on therapy in patients who are resistant to multidrug regimens. The antihypertensive benefit in this setting is not limited to patients with classically defined primary aldosteronism, suggesting aldosterone excess as a cause of resistant hypertension to a degree that is greater than is indicated by measurement of either plasma or urinary aldosterone levels. Aldosterone and Incident HypertensionMultiple, independent studies suggest that aldosterone contributes broadly to the development of hypertension separate from cases of classically defined primary aldosteronism. The role of aldosterone in causing hypertension is supported by cross-sectional studies that relate plasma aldosterone levels to ambulatory BP measurements, by prospective analyses that indicate that aldosterone levels predict development of hypertension, and by studies that confirm the broad antihypertensive efficacy of aldosterone antagonists in treating presumed primary hypertension. Importantly, in these studies, indices of renin activity were not related to BP levels, suggesting an autonomous role of aldosterone in causing hypertension that is independent of renin-angiotensin II.Cross-sectional studies demonstrate a significant correlation between plasma aldosterone and 24-h ambulatory BP levels. The relation is particularly strong in black individuals. In an analysis of black American and white French Canadian patients with primary hypertension, supine and standing plasma aldosterone levels were significantly correlated with daytime and nighttime systolic and diastolic BP levels in the black patients...

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Section: Hypertension and Primary Aldosteronismmentioning

confidence: 93%

Aldosteronism and Hypertension

Calhoun¹

2006

Clinical Journal of the American Society of Nephrology

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“…7 This explains the preponderance of PA cases due to Conn's adenoma by two-thirds to three-quarters over and above that of IHA in most PA series prior to the introduction of ARR as a screening test. 6,[13][14][15][16] However, with the shift in PA definition to that of assessing the lack of aldosterone suppressibility, IHA is more readily diagnosed and the use of ARR 7,17,18 as a screening tool has precipitated this. In fact, hypertensive patients with poorly suppressible aldosterone secretion in response to salt loading were described nearly three decades ago.…”

Section: Introductionmentioning

confidence: 99%

Is aldosterone the missing link in refractory hypertension?: aldosterone-to-renin ratio as a marker of inappropriate aldosterone activity

2002

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Use of the random aldosterone-to-renin ratio (ARR) as a reliable marker of inappropriate aldosterone activity has led to primary aldosteronism (PA) being increasingly diagnosed in hypertensive patients. At least 10% of hypertensives have been found to have PA, the majority of whom presumably have bilateral adrenal hyperplasia or idiopathic hyperaldosteronism as an aetiology for PA. Whilst these patients clearly have excess aldosterone activity, they have in common many features that are found in hypertensive patients in general, amongst which include heightened angiotensin II adre-

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“…19 This is no longer a simple process and it is my contention that most of the patients being identified by this screening test have what I would have called low renin hypertension or idiopathic hyperplasia depending where the cut-off point is drawn. The same argument applies to recent studies within Tayside where a similar prevalence of primary aldosterone excess is claimed 20 (again evidence from surgical cure is lacking).…”

Section: Hyperaldosteronism-common Enough To Hunt?mentioning

confidence: 65%

Primary aldosteronism, a common entity? the myth persists

Padfield

2002

J Hum Hypertens

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Primary aldosterone excess or hyperaldosteronism is an important cause of hypertension which, when associated with an aldosterone secreting adenoma, is amenable to surgical cure. The biochemical hallmarks of the condition are a relative excess of aldosterone production with suppression of plasma levels of renin (a proxy for angiotensin II, the major trophic substance regulating aldosterone secretion). This combination of a high aldosterone and a low renin is however more commonly associated with 'nodular hyperplasia' of the adrenal glands, a condition not improved by surgery and variably responsive to the effects of the mineralocorticoid antagonist, spironolactone. Until recently the prevalence of either form of secondary hypertension has been thought to be low such that few clinicians 'hunted' for it in the absence of hypokalaemia (the traditional clue for the syndrome). This view has been challenged, firstly by the realisation that no more than 50% of such patients will have a low plasma potassium and secondly by the assumption that a 'normal' plasma Keywords: primary aldosterone excess; Conn's syndrome; low-renin; hyperaldosteronism; aldosterone/renin ratio Introduction I have lived and worked throughout a quarter of a century where clinical hypertension research has been both productive and exciting. This has been no more so that in the area of mineralocorticoid hypertension.Fashions change however and I well remember starting out in hypertension research in a unit where every patient had a full assessment of the reninangiotensin-aldosterone system. This was only partly for research purposes as there was a genuine belief that this system was intimately concerned in the pathogenesis of high blood pressure. As the years have passed my own philosophical approach to the hypertensive patient has changed. I no longer believe that most hypertensive patients harbour a single causative factor, the removal of which will cure hypertension. I have moved from a time when we investigated everybody 1 to one where I investigate few and I am not persuaded that this is the wrong approach.

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High prevalence of primary aldosteronism in the Tayside hypertension clinic population

Cited by 248 publications

References 23 publications

Aldosteronism and Hypertension

Aldosteronism and Hypertension

Is aldosterone the missing link in refractory hypertension?: aldosterone-to-renin ratio as a marker of inappropriate aldosterone activity

Primary aldosteronism, a common entity? the myth persists

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