Prevalence of primary aldosteronism among prehypertensive and stage 1 hypertensive subjects

Abstract

Recent studies have reported a high prevalence of primary aldosteronism among patients with severe hypertension. However, the prevalence of this disease among normotensive and mildly hypertensive patients has not been determined. The aim of this study was to examine the prevalence of primary aldosteronism among prehypertensive and stage 1 hypertensive subjects. A total of 292 adult subjects with hypertension or prehypertension was screened for primary aldosteronism. Subjects with a plasma aldosterone concentration (ng per 100 ml) to plasma renin activity (ng ml -1 h -1 ) ratio (ARR) above 20 underwent confirmatory captopril suppression testing. A total of 54 subjects (18.5%) had an ARR above 20. A captopril suppression test was performed in 17 of 54 subjects with probable primary aldosteronism. The test confirmed the diagnosis of primary aldosteronism in 11 (64.7%) of 17 patients, giving a least prevalence of 3.8% for this disease. The 11 patients with primary aldosteronism had a mean ± s.d. systolic blood pressure of 139 ± 4 mm Hg, diastolic blood pressure of 95 ± 10 mm Hg and serum potassium of 4.46 ± 0.48 mEq l -1 at the time of screening test. The prevalence of primary aldosteronism as could be assessed in this study was at least 6.8% in prehypertensive patients, 3.3% in stage 1 hypertensive patients and 3.1% in stage 2 hypertensive patients. In conclusion, this study suggests a high prevalence of primary aldosteronism among prehypertensive and stage 1 hypertensive Japanese patients. Significant numbers of prehypertensive individuals may have subclinical forms of this disease.

Comparison of eplerenone and spironolactone for the treatment of primary aldosteronism

“…Primary aldosteronism (PA) is the most common form of secondary hypertension, with an estimated prevalence of 5-15% in all hypertensive patients [1,2]. Excess aldosterone has adverse cardiovascular and renal consequences in patients with hypertension and in patients with diabetes mellitus or chronic renal disease [3,4].…”

Prevalence of Primary Aldosteronism in an Urban Hypertensive Population

“…confirmatory testing, would have confirmed positive for PA. The starting sample size of 296, however, was comparable to other primary care prevalence studies in which retention of subjects for further screening was low, and prevalence was similar to ours (13,21,22 Using a similar ARR cutoff as our study (ARR ≥ 25), they reported a 7.5% prevalence on screening. Although the prevalence in that study is similarly low to that demonstrated in our population, the U.K. study utilized a more stringent ARR cutoff for screening (ARR cutoff ≥ 40) (23).…”

“…performed in limited populations, specifically those with patients referred to subspecialty centers for the management of hypertension. Few studies have endeavored to determine the disease prevalence in the primary care setting (21)(22)(23)(24). Furthermore, screening of patients for PA in general hypertensive populations is often overlooked unless patients have concomitant hypertension and hypokalemia.…”

Cure for a resistant hypertension case that required seven drugs for blood pressure control

“…This is far more common than in people with non-resistant hypertension, 2 although a high prevalence of PA has also been reported among prehypertensive and stage 1 hypertensive Japanese patients. 3 The first step in screening for PA is measurement of the aldosterone-to-renin ratio (ARR); a combined evaluation of ARR with the serum sodium to urinary sodium divided by the serum potassium 2 to urinary potassium ratio (ARRÂSUSPPUP) seems to be the most reliable screening test, with a sensitivity of 92.3% and a specificity of 93.9%. 4 Surgery is an option in patients with unilateral adrenal disease.…”