Increasing Incidence of Primary Aldosteronism in Western Sweden During 3 Decades – Yet An Underdiagnosed Disorder

Abstract

Context Primary aldosteronism (PA) is the most common cause of secondary hypertension. Yet, the incidence of PA in the general population has not been studied. Objective To estimate the incidence of PA in the general population. Design and methods Patients who had received a diagnostic code for PA between 1987 and 2016 were identified in the Swedish National Patient Registry. Assessment of clinical and biochemical data was used to validate the diagnosis. The annual incidence of PA was calculated by using the number of inhabitants in the Västra Götaland County as reference. Results Of 570 identified patients, 473 (83 %) had confirmed PA. Eligible for the incidence analysis were 416 patients, 248 (60%) men and 168 (40%) women, diagnosed with PA between 1987-2016. The mean (±standard deviation) age at diagnosis was 56±12 years. The median (interquartile range) annual incidence was 2 (1-2) cases per million between 1987 and 1996, 6 (4-9) cases per million between 1997 and 2006 and 17 (12-24) cases per million between 2007 and 2016. At the end of the study (December 31 st 2016), 386 patients with confirmed PA were alive and living in the Västra Götaland County, giving a prevalence of 231 cases per million (0.022%). Conclusions Despite increasing incidence, the proportion of patients identified with PA is lower than expected. Given the serious consequences of untreated PA, the noticeably low prevalence at the end of the study stresses the need to increase the awareness of PA among health care providers.

Ambulatory fludrocortisone suppression test in the diagnosis of primary aldosteronism: Safety, accuracy and cost‐effectiveness

“…In the FST amb group, the dose of slow‐release potassium chloride tablets was increased in 113 cases (74.8%) with 4 (0–28) tablets, while in the FST in group, the dose was increased in nine patients (60%) with 10.5 2–25 tablets ( p = .001) (Table 3). The dosage of slow‐release potassium chloride tablets was usually increased on Days 1 or 2 (51 cases [29.8%] and 59 cases [34.5%], respectively).…”

“…Primary aldosteronism (PA) is the most common endocrine cause of secondary hypertension 1 . However, PA is underdiagnosed 2 with reported prevalence rates among patients with hypertension of 4%–14% 3–5 in primary care and 1%–29.8% in referral centres 2,6–9 . The disease is characterised by hypertension, hypokalemia/normokalemia and metabolic alkalosis with diffuse clinical features such as muscle weakness, fatigue, polyuria and polydipsia 10,11 .…”

Primary aldosteronism

“…While prevalence is high in research studies, primary aldosteronism is not often diagnosed in real life. For example, a prevalence of 0.022% was reported in the Västra Götaland County in Sweden despite increasing incidence,10 while 0.1-0.45% of hypertensive patients were diagnosed with primary aldosteronism in a survey of Australian GPs 11. The low prevalence is expected where at-risk patients are not routinely screened for primary aldosteronism.…”

Clinical Translationality of KCNJ5 Mutation in Aldosterone Producing Adenoma

“…Primary aldosteronism (PA) is found in 5–7% of all hypertensive patients [ 8 , 9 , 10 , 11 , 12 , 13 ] and even explains 20% of patients with third-degree hypertension [ 14 ]. Despite its frequency, less than 1% of patients with PA undergo screening and progress to treatment throughout their lifetime [ 15 , 16 , 17 , 18 , 19 , 20 ]. One reason for the underdiagnosis may be that health care providers are not fully aware of the high frequency of PA in hypertensive patients.…”