Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study

Δούμα, Στέλλα; Petidis, Konstantinos; Doumas, Michael; Papaefthimiou, Panagiota; Triantafyllou, Αreti; Kartali, Nikoleta; Papadopoulos, Nikolaos G.; Vogiatzis, Konstantinos; Zamboulis, Chrysanthos

doi:10.1016/s0140-6736(08)60834-x

Cited by 470 publications

(331 citation statements)

References 35 publications

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“…Using current methodology, the estimated prevalence of PA has been found to range from 4.6 to 16.6% (1,3,5,6,7). However, all previous studies have solely evaluated the renin stimulatory effect on aldosterone secretion without taking into consideration the adrenocorticotrophin (ACTH) effect.…”

Section: Introductionmentioning

confidence: 99%

A new highly sensitive and specific overnight combined screening and diagnostic test for primary aldosteronism

Tsiavos

Markou

Papanastasiou

et al. 2016

European Journal of Endocrinology

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Context: Primary aldosteronism (PA) is the most common cause of endocrine hypertension that is diagnosed following a two-step process: an initial screening test, based on the serum aldosterone-to-renin ratio (ARR), followed by a relatively laborious and time-consuming confirmatory test to document autonomous aldosterone (ALD) secretion. Objective: The aim of this study is to develop a simple overnight test for the early and definite diagnosis of PA. Patients and methods: Totally, 148 hypertensive patients underwent a fludrocortisone-dexamethasone suppression test (FDST) and the new overnight diagnostic test (DCVT) using pharmaceutical RAAS (renin-angiotensin-aldosterone system) blockade with dexamethasone, captopril and valsartan. Results: Of the 148 patients, 45 were diagnosed as having PA and they all normalized their elevated blood pressure (BP) after administration of spironolactone or eplerenone. The remaining 103 patients were considered as having essential hypertension and served as controls. Using ROC analysis, the estimated sensitivity and specificity were 91 and 100%, respectively, for the post-FDST ARR, whereas 98% and 89% and 100% and 82% for the post-DCVT ARR and post-DCVT ALD, respectively, with selected cutoffs of 0.32 ng/dL/μU/mL and 3 ng/dL respectively. However, considering these cutoffs simultaneously, the estimated sensitivity and specificity were 98 and 100% respectively. Applying these cutoffs, the diagnosis of PA was confirmed in 44 (98%) of the 45 patients who were considered to have the disease. Conclusions: In this study, a highly sensitive and specific, low-cost, rapid, safe, and easy-to-perform diagnostic test (DCVT) for PA is described, which could be utilized on an outpatient basis potentially substituting conventional laborious testing.

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Section: Introductionmentioning

confidence: 99%

A new highly sensitive and specific overnight combined screening and diagnostic test for primary aldosteronism

Tsiavos

Markou

Papanastasiou

et al. 2016

European Journal of Endocrinology

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“…[4] The previous assumption that PA was a rare disease representing only a miniscule number of patients, has been overturned by evidence from multiple retrospective and prospective studies. Recent studies have demonstrated an overall prevalence of 5% to 10% among all hypertensive patients [5][6][7][8][9][10][11] and as high as 20% among the population of patients considered to have resistant hypertension. [12] When considering that around one-third of adults in the United States over the age of 18 have essential hypertension, [13] the number of patients potentially with undiagnosed PA is staggering.…”

Section: Discussionmentioning

confidence: 99%

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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“…On the other hand, in a retrospective observational study conducted in 2008, Douma et al [17] reported a prevalence of PA of 11.3% among 1,616 patients with resistant hypertension who had been evaluated over 20 years. Although the prevalence was so high, it was substantially lower than previously reported.…”

Section: Introductionmentioning

confidence: 98%

“…Although the prevalence was so high, it was substantially lower than previously reported. On the basis of this finding, the authors assumed that the prevalence of primary hyperaldosteronism in the general unselected hypertensive population was much lower than that reported until then [17]. Hence, prevalence of PA could currently be estimated at 5-12%, suggesting that PA may be the most common endocrine form of hypertension [18].…”

Section: Introductionmentioning

confidence: 99%

Increasing Incidence of Primary Aldosteronism in Patients Investigated for Resistant Hypertension: An Observational Study from a Nephrology Unit

Giudice¹

2012

J Nephrol Therapeutic

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Introduction: Primary Aldosteronism (PA) is a secondary form of hypertension characterized by an autonomous and inappropriately high production of aldosterone. Its prevalence is 5-12% and the two main subtypes are the Bilateral Adrenal Hyperplasia (BAH) and the Aldosterone-Producing Adenoma (APA). In this study, we report the results of an evalutation of some patients diagnosed with PA in a Nephrology Unit between 1987-2011.

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Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study

Cited by 470 publications

References 35 publications

A new highly sensitive and specific overnight combined screening and diagnostic test for primary aldosteronism

A new highly sensitive and specific overnight combined screening and diagnostic test for primary aldosteronism

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

Increasing Incidence of Primary Aldosteronism in Patients Investigated for Resistant Hypertension: An Observational Study from a Nephrology Unit

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