Prevalence of primary hyperaldosteronism assessed by aldosterone/renin ratio and spironolactone testing

Hood, Sue S.; Cannon, John; Foo, Roger; Brown, Morris J.

doi:10.7861/clinmedicine.5-1-55

Cited by 44 publications

(38 citation statements)

References 30 publications

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“…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). Other studies in the primary care setting from Sweden, Singapore, and Chile report a PA prevalence between 1.6% and 8.5% (10,22,24,25).…”

Section: Discussionmentioning

confidence: 59%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Primary Aldosteronism in an Urban Hypertensive Population

Galati¹,

Cheesman²,

Springer-Miller³

et al. 2016

Endocrine Practice

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Abstract:Objective: To determine the prevalence of Primary Aldosteronism (PA) in hypertensive patients presenting to the primary care clinic at The Mount Sinai Hospital, regardless of the degree of hypertension and to identify clinical criteria that should prompt screening for PA.Methods: An ARR (cutoff ≥20, with PAC ≥ 10 and suppressed renin) was used to prospectively screen 296 hypertensive patients (BP ≥ 140/90) over the age of 18 from August 2012 through May 2013.Subjects who screened positive then underwent confirmatory oral salt load testing (OSLT).Results: Of the 296 patients, fourteen screened positive for PA, an overall prevalence of 4.7%. Six of the fourteen cases underwent confirmatory OSLT upon which two confirmed positive, prevalence of 0.7%.Overall, patients with confirmed PA were more likely to have resistant hypertension (42.9% vs. 18.1% (p= 0.0334)) and require more anti-hypertensive agents (2.8 ±1.2 agents vs 2.1 ± 1.1 agents (p=0.0213)).There was a trend toward lower potassium values in the cases.Conclusion: The prevalence of PA in our clinic is much lower than in reports from certain "at-risk" populations. PA screening is indicated in patients with resistant hypertension, regardless of serum potassium levels. Introduction:

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Prevalence of Primary Aldosteronism in an Urban Hypertensive Population

Galati¹,

Cheesman²,

Springer-Miller³

et al. 2016

Endocrine Practice

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“…[4][5][6][7] Using the renin-mass assay, we were able to define a normal range in measurements on 850 randomly selected patients in primary care, excluding those on confounding drugs. 3 Whereas the detection limit of the renin activity assay lay within the usually quoted normal range (i.e., the lower 5% of levels were undetectable) this is not the case for renin mass assay. This permits recognition of patients in whom renin secretion is suppressed below the normal range.…”

Section: Discussionmentioning

confidence: 99%

“…All three patients had severe resistant hypertension that was reversed by adrenalectomy, with blood pressure (BP) falling to target despite withdrawal of all but one to two drugs. Use of aldosterone-renin ratio (ARR) was first introduced in 1981 3 and has become widely used in recent years as a screening test for primary hyperaldosteronism. However, it does not differentiate between adenoma and bilateral adrenal hyperplasia.…”

Section: Introductionmentioning

confidence: 99%

Primary hyperaldosteronism due to adrenal microadenoma: a curable cause of refractory hypertension

Myint

Watts

Appleton

et al. 2008

J Renin Angiotensin Aldosterone Syst

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Paper AbstractThe diagnosis of primary hyperaldosteronism due to microadenoma or unilateral adrenal hyperplasia can be challenging, since hypokalaemic alkalosis, high plasma aldosterone and a definite adenoma on imaging may all be absent. Method and result. We describe three cases of resistant hypertension (on > 5 antihypertensives) where hyperaldosteronism was suspected because of a suppressed plasma renin level despite treatment with multiple drugs which normally elevate renin. Renin mass was measured by a double-site chemi-immunoluminometric assay.All patients had normal plasma aldosterone levels. Hypokalaemia was present in the first two cases but computed tomography did not show clear cut adenomas.Adrenal vein sampling (AVS) revealed lateralisation (> 4 times higher aldosterone to cortisol ratio (ACR) on the affected than contra-lateral side).The third patient was normokalaemic and AVS showed only minimal lateralisation (ACR 1.3:1).The severe hypertension in all cases was reversed by adrenalectomy, with blood pressure falling to target despite withdrawal of all but one to two drugs. Conclusions. The robotic assay of renin mass permits rapid detection of patients in whom plasma renin is suppressed below the normal range.A suppressed plasma renin indicates abnormal Na + -retention, and -when not overcome by drugs such as angiotensinconverting enzyme-inhibitors or angiotensin receptor blockers -may be the only clue to a curable adrenal adenoma.AVS is required to demonstrate lateralisation of aldosterone secretion, justifying adrenalectomy.

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“…Spironolactone also effectively decreases BP in patients with or without hyperaldosteronism [10][11][12][13][14][15][16][17][18] . Small, uncontrolled studies have also shown its effectiveness in patients with resistant hypertension [19][20][21][22] .…”

Section: Introductionmentioning

confidence: 99%

Addition of Spironolactone in Patients With Resistant Arterial Hypertension (Aspirant) - Study Protocol

Václavík¹,

Sedlak²,

Plachý³

et al. 2011

BIOMED PAP

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Background. There is currently limited data on which drug should be used to improve blood pressure control in patients with resistant hypertension. Recent observational trials reported spironolactone as having good effects. This study is designed to assess the effect of the addition of 25 mg of spironolactone on blood pressure (BP) in patients with resistant arterial hypertension.Methods. Patients with office systolic BP >140 mmHg or diastolic BP >90 mmHg despite treatment with at least 3 antihypertensive drugs including a diuretic, are enrolled in this double-blind, placebo-controlled, multicentre trial. Patients are randomly assigned to receive spironolactone or a placebo at a ratio of 1:1 by the method of simple randomisation. Our primary endpoints are to show a statistically significant difference in the fall of mean day-time systolic and diastolic BP by ambulatory blood pressure monitoring (ABPM), between the spironolactone and placebo groups, after 8 weeks of treatment. Secondary outcomes are changes of serum potassium, natrium, creatinine, body weight, casual blood pressure in office, difference in the fall of mean night-time and 24-hour ABPM BP and treatment response depending on different baseline levels of aldosterone and aldosterone/PRA ratio. This study is registered with ClinicalTrials.gov, No. NCT00524615.Discussion. If spironolactone proves effective, it might become the standard of treatment in patients with resistant arterial hypertension. BACKGROUND

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Prevalence of primary hyperaldosteronism assessed by aldosterone/renin ratio and spironolactone testing

Cited by 44 publications

References 30 publications

Prevalence of Primary Aldosteronism in an Urban Hypertensive Population

Prevalence of Primary Aldosteronism in an Urban Hypertensive Population

Primary hyperaldosteronism due to adrenal microadenoma: a curable cause of refractory hypertension

Addition of Spironolactone in Patients With Resistant Arterial Hypertension (Aspirant) - Study Protocol

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