Hypertension Caused by Primary Hyperaldosteronism: Increased Heart Damage and Cardiovascular Risk

Abad-Cardiel, M.; Álvarez-Álvarez, Beatriz; Luque-Fernandez, Loreto; Fernández, Cristina; Fernández-Cruz, A; Claros, Nieves Martell

doi:10.1016/j.rec.2012.07.017

Cited by 15 publications

(12 citation statements)

References 33 publications

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“…According to current literature, patients with primary aldosteronism own a high cardiovascular risk [14,16], mainly due to the deleterious effect of high aldosterone levels [17,18]. Specific treatment offers an optimal BP control for these patients, by reducing the exposition to aldosterone.…”

Section: Discussionmentioning

confidence: 99%

“…It is under debate that hypertensive population should be tested for primary aldosteronism, if hypokalemia is accepted as not indispensable [3]. As its prevalence is higher in a number of clinical situations with normokalemia, it should be suspected in stage 2-3 hypertension (8-13%) [10], resistant hypertension (17-23%) [5,11], hypertension associated with adrenal incidentaloma (median 2%, range 1.1-10%) [12], hypertension associated with family history of early-onset hypertension or stroke under 50-year-old individuals [13], hypertensive first-grade relatives of already diagnosed patients with primary aldosteronism [4], and patients who have suffered several hypertensive crisis during the course of their hypertension history (12.7%) [14] as described by our group.…”

Section: Introductionmentioning

confidence: 99%

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Primary aldosteronism and its various clinical scenarios

Martell-Clarós

Abad-Cardiel

Álvarez-Álvarez

et al. 2015

Journal of Hypertension

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Primary aldosteronism and its various clinical scenarios

Martell-Clarós

Abad-Cardiel

Álvarez-Álvarez

et al. 2015

Journal of Hypertension

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“…When compared to age and gender matched essential hypertension patients with the same degree of blood pressure elevation, patients with PA have increased risk of stroke, non-fatal myocardial infarction, and atrial fibrillation. [14,15] Our patient demonstrates a prime example of the cardiovascular effects that uncontrolled hypertension leads too witnessed by his NSTEMI presentation, along with the severe concentric left ventricular hypertrophy and grade 3 diastolic dysfunction found on his echocardiogram. Primary aldosteronism is also associated with abnormal glucose metabolism and insulin resistance, [16] and treatment of PA with unilateral adrenalectomy has been shown to be protective against development of new onset diabetes mellitus.…”

Section: Discussionmentioning

confidence: 83%

The forgotten cause of hypertension: A case report and literature review of the prevalence, diagnosis and management of primary aldosteronism

Barlow

Abdel‐Latif

2018

CRIM

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In recent years, primary aldosteronism (PA) has been found to have a much higher prevalence than previously thought, especially among those with resistant hypertension. As hypertension has become a prominent public health issue affecting billions of people, the number of patients potentially affected by PA is a significant. Current medical and surgical therapies for PA are highly effective, and as untreated PA can lead to significant cardiovascular morbidity and mortality this stresses the importance of astute diagnosis and management on part of physicians. We present a case of a patient presenting with cardiovascular complications of untreated primary aldosteronism and review recent guidelines regarding screening, diagnosis, and management.Key Words: Conn's Syndrome, Adrenal hyperplasia, Primary aldosteronism, Hyperaldosteronism, Resistant hypertension BACKGROUNDPrimary aldosteronism (PA), or more commonly known as primary hyperaldosteronism, is the leading cause of secondary hypertension. [1,2] Once thought to be an uncommon disease, recent studies have shown that PA is increasingly common and present in anywhere from 5% to 10% of all those with hypertension. As hypertension is one of the most common chronic medical conditions, it is imperative that physicians involved in long-term management of these patients are familiar with recent guidelines surrounding PA diagnosis and management. When left undiagnosed, patients with primary aldosteronism have increased risk of cerebrovascular and cardiovascular events, which stresses the importance of proper screening, especially as current medical and surgical therapies are highly successful. We report a case of primary aldosteronism in a patient presenting with a cardiovascular event. Our case highlights the adverse complications of long standing primary aldosteronism and reviews the current literature regarding the prevalence of PA as well as its diagnosis and long-term management. CASE HISTORYA 65-year-old male with past medical history of poorly controlled hypertension presented to emergency department with acute onset substernal chest pain. His only known medical history was that of long-standing poorly controlled hypertension, that was self reported by the patient and confirmed by review of his previous blood pressure recordings and outpatient provider notes over the past several years in the hospital's electronic medical record. He was a lifelong non- Following the procedure, he remained hypertensive, despite up-titration to maximal doses of nifedipine, lisinopril and hydrochlorothiazide. He was also persistently hypokalemic with potassium levels ranging from 2.5 to 3.4 mmol/L, necessitating aggressive oral potassium supplementation. Given concern for secondary hypertension, plasma aldosterone and renin levels were drawn and were 17.5 ng/dl and 0.466 ng/ml/hr respectively, giving an elevated aldosterone renin ratio (ARR) of 37.5. A non-enhanced CT of the abdomen was performed and demonstrated slight enlargement and irregular thickening of the left adrenal...

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“…PA is one of the most common identifiable causes of TRH . The prevalence of PA was reported to be between 1% and 10% in uncomplicated hypertension and between 7% and 20% in patients with resistant hypertension . The wide range of prevalence of PA may be related to the study design or population studied.…”

Section: Discussionmentioning

confidence: 99%

“…Primary aldosteronism (PA), one of the most common causes of treatment‐resistant hypertension (TRH), has been identified in up to 20% of patients with TRH seen in tertiary hypertension centers . TRH patients with medication nonadherence (ie, pseudo‐TRH) are presumed to have a lower prevalence of PA than those with true TRH.…”

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confidence: 99%

Cost‐Effectiveness of Therapeutic Drug Monitoring in Diagnosing Primary Aldosteronism in Patients With Resistant Hypertension

Velasco

Chung

Raza

et al. 2015

J of Clinical Hypertension

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Primary aldosteronism (PA) is present in up to 20% of patients with treatment resistant hypertension (TRH). Investigation for PA in TRH is recommended by the current guidelines after medication nonadherence is excluded. Studies using therapeutic drug monitoring (TDM) have shown more than 50% of patients with TRH are nonadherent to their prescribed antihypertensive medications. However, the relationship between the prevalence of PA and medication adherence as confirmed by TDM has not been previously assessed. A retrospective analysis from our hypertension referral clinic showed that prevalence of PA in adherent TRH patients by TDM was significantly higher than in nonadherent patients (28% vs. 8%, p<0.05). Furthermore, a cost analysis showed that TDM-guided PA screening was $590.69 less expensive per patient, with minimal impact on the diagnostic accuracy. Our data supports a TDM-guided PA screening approach as a cost saving strategy compared to routine PA screening for TRH.

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Hypertension Caused by Primary Hyperaldosteronism: Increased Heart Damage and Cardiovascular Risk

Cited by 15 publications

References 33 publications

Primary aldosteronism and its various clinical scenarios

Primary aldosteronism and its various clinical scenarios

The forgotten cause of hypertension: A case report and literature review of the prevalence, diagnosis and management of primary aldosteronism

Cost‐Effectiveness of Therapeutic Drug Monitoring in Diagnosing Primary Aldosteronism in Patients With Resistant Hypertension

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