Prevalence of primary hyperaldosteronism in mild to moderate hypertension without hypokalaemia

Abstract

Screening for primary hyperaldosteronism (PHA) is often indicated in individuals with resistant hypertension or hypokalaemia. However, in the far larger subset of the hypertensive population who do not fit into these criteria, the evidence for screening is conflicting and dependent on the disease prevalence. The purpose of this study was to examine the prevalence of PHA in a large population with mild to moderate hypertension and without hypokalaemia using a carefully controlled study protocol including a normotensive control population. Hypertensive subjects underwent medication washout and both hypertensive and normotensive subjects placed on a high-sodium diet prior to biochemical and haemodynamic testing. Study specific cutoff values were based on results from the normotensive population studied under identical conditions. A screening test (serum aldosterone/PRA ratio [ARR]425 with a serum aldosterone level 48 ng/dl) was followed by a confirmatory test (urine aldosterone excretion rate [AER] 417 lg/ 24 h) to demonstrate evidence of PHA. An elevated ARR with a concomitant elevated serum aldosterone was present in 26 (7.5%) individuals. Of these, 11 (3.2%) had an elevated AER, consistent with evidence of PHA. Individuals with PHA had higher blood pressure and lower serum potassium levels while on a high-sodium diet. Sodium restriction neutralized these differences between PHA and essential hypertensives. The prevalence of PHA in this mild to moderate hypertensive population without hypokalaemia is at most 3.2%, a rate that might lead to excessive false positives with random screening in comparable populations. Hyperaldosteronism, when present, is responsive to sodium restriction.

Is There an Unrecognized Epidemic of Primary Aldosteronism? (Con)

“…Although this study 26 supports a much lower prevalence of PA than Rossi et al, 27 the data cannot be used as evidence for the prevalence in a nonselected population nor can the presence of APA be documented as it can be in some of the patients in the study by Rossi et al…”

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).…”

Diagnosis dan Tata Laksana Sindrom Conn/Hiperaldosteronisme Primer: Sebuah Studi Kasus

“…Sindrom ini dilaporkan pertama kali pada tahun 1955 oleh Jerome W. Conn. 3 Sehingga, hiperaldosteronisme primer juga dikenal sebagai sindrom Conn. Pada saat ini, banyak laporan yang menunjukkan kejadian hiperaldosteronisme primer yaitu berkisar antara 3-20%. 4 Diagnosis sindrom Conn biasanya ditegakkan pada pasien dekade ketiga sampai keenam. Pada kasus ini, pasien mulai muncul keluhan di awal dekade ketiga dan sudah tiga kali dirawat di rumah sakit karena hipokalemia.…”