Primary aldosteronism in hypertensive patients: clinical implications and target therapy

Papanastasiou, Labrini; Markou, Αthina; Παππά, Θεοδώρα; Gouli, Aggeliki; Tsounas, Panagiotis; Fountoulakis, Stelios; Kounadi, Theodora; Tsiama, V.; Dasou, Aikaterini; Gryparis, Alexandros; Samara, Christianna; Zografos, George; Kaltsas, Gregory; Chrousos, George P.; Piaditis, George

doi:10.1111/eci.12286

Cited by 22 publications

(21 citation statements)

References 41 publications

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“…These results suggest that dexamethasone administration is expected to have a similar beneficial effect on the performance characteristics of FST and support the view that both the ACTH and renin stimulatory effects on aldosterone secretion need to be considered for making the diagnosis (60,61). These results have recently been confirmed by expanding our initial study including a much higher number of individuals (327 hypertensive and 100 controls) (78).…”

Section: Prevalence Of Pa In Hypertension and Pre-hypertensionsupporting

confidence: 76%

“…Similarly, the cut-off value of post-FDST ARR was also lower (26 pmol/mU vs 32 pmol/mU), whereas the post-FDST aldosterone levels were higher (82 pmol/l vs 74 pmol/l) albeit without alteration in the prevalence of PA that was found to be 29% (78). The observed different test characteristics in the last study may be attributed to the higher number of controls included and the stricter selection criteria adopted.…”

Section: Prevalence Of Pa In Hypertension and Pre-hypertensionmentioning

confidence: 82%

“…As already mentioned, several cross-sectional and prospective studies in unselected hypertensive populations have shown that the prevalence of PA is much higher than previously believed, although it varies significantly between studies ranging from 4.6 to 16.6% when confirmatory tests to diagnose PA were used (Table 2) (5,6,7,8,21,71,75,76,77,78,79,80,81,82). However, in patients with resistant hypertension, the prevalence of PA is reported to be even higher ranging from 17 to 23% (16,83).…”

Section: Prevalence Of Pa In Hypertension and Pre-hypertensionmentioning

confidence: 93%

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PROGRESS IN ALDOSTERONISM: A review of the prevalence of primary aldosteronism in pre-hypertension and hypertension

Piaditis

Markou

Papanastasiou

et al. 2015

European Journal of Endocrinology

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Primary aldosteronism (PA) secondary to excessive and/or autonomous aldosterone secretion from the renin-angiotensin system accounts for w10% of cases of hypertension and is primarily caused by bilateral adrenal hyperplasia (BAH) or aldosterone-producing adenomas (APAs). Although the diagnosis has traditionally been supported by low serum potassium levels, normokalaemic and even normotensive forms of PA have been identified expanding further the clinical phenotype. Moreover, recent evidence has shown that serum aldosterone correlates with increased blood pressure (BP) in the general population and even moderately raised aldosterone levels are linked to increased cardiovascular morbidity and mortality. In addition, aldosterone antagonists are effective in BP control even in patients without evidence of dysregulated aldosterone secretion. These findings indicate a higher prevalence of aldosterone excess among hypertensive patients than previously considered that could be attributed to disease heterogeneity, aldosterone level fluctuations related to an ACTH effect or inadequate sensitivity of current diagnostic means to identify apparent aldosterone excess. In addition, functioning aberrant receptors expressed in the adrenal tissue have been found in a subset of PA cases that could also be related to its pathogenesis. Recently a number of specific genetic alterations, mainly involving ion homeostasis across the membrane of zona glomerulosa, have been detected in w50% of patients with APAs. Although specific genotype/phenotype correlations have not been clearly identified, differential expression of these genetic alterations could also account for the wide clinical phenotype, variations in disease prevalence and performance of diagnostic tests. In the present review, we critically analyse the current means used to diagnose PA along with the role that ACTH, aberrant receptor expression and genetic alterations may exert, and provide evidence for an increased prevalence of aldosterone dysregulation in patients with essential hypertension and pre-hypertension.

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Section: Prevalence Of Pa In Hypertension and Pre-hypertensionsupporting

confidence: 76%

Section: Prevalence Of Pa In Hypertension and Pre-hypertensionmentioning

confidence: 82%

Section: Prevalence Of Pa In Hypertension and Pre-hypertensionmentioning

confidence: 93%

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PROGRESS IN ALDOSTERONISM: A review of the prevalence of primary aldosteronism in pre-hypertension and hypertension

Piaditis

Markou

Papanastasiou

et al. 2015

European Journal of Endocrinology

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“…Some authors found that 47% of patients suffering from PA had ARR above 30 [30] (usually taken as the cut-off level) and 28% of those patients had ARR above 50 [31]. In our study it was found that the ARR above 8.25 supports the diagnosis of primary aldosteronism.…”

Section: Discussionsupporting

confidence: 66%

The prevalence of primary aldosteronism (PA) in a group of 350 hypertensive patients

Michalak

Jagodzińska²,

Zieleniewski³

2015

Arterial Hypertension

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SummaryBackground Hypertension is one of the commonest diseases worldwide. Its prevalence is estimated to approximately 25% of the population. In addition, hypertension is an important risk factor for increased cardiovascular events. In most cases it is of idiopathic origin, but may also be due to another disease, e.g. endocrine dysfunction. Primary aldosteronism (PA) is a common cause of resistant hypertension; its proper diagnosis determines further therapy. The aim of this study was to evaluate the prevalence of PA in a group of 350 patients (240 women and 110 men) with hypertension. Material and method All patients underwent hormonal tests including assessment of the levels of: ACTH, cortisol (baseline and in dexamethasone suppression test), DHEA-S, chromogranin A, VMA urine excretion, aldosterone and active renin. Afterwards, an intravenous load test with 0.9% neutral saline solution was performed. Abdominal ultrasound was performed in all patients, and abdominal computed tomography only in patients with abnormal hormonal tests. Other forms of secondary hypertension were previously excluded. Results Primary aldosteronism was diagnosed in 58 patients (16.6%) -38 women and 20 men. Adrenal adenoma was found in 20 patients (34.5%), and idiopathic hyperaldosteronism in 38 patients (65.5%). Hypokalaemia occurred in 25 patients (43.1%). Moreover, it was found that the aldosterone-renin ratio above 8.25 supports the diagnosis of PA. Conclusion We conclude that the diagnosis of PA should not be limited only to the hypertensive patient with hypokalaemia. PA is an important cause of hypertension, especially among patients with difficulties in normalization of blood pressure with standard pharmacological treatment. key words: hypertension, aldosterone, primary hyperaldosteronism

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“…Furthermore, in the present study, the maximum dose of MRAs used was up to 100 mg, whereas other studies have used higher doses of up to 200 mg (27). Previous studies performed in our unit have revealed that the prevalence of PA in unselected patients with hypertension ranges from 29 -32% (3,28), which added to the 27% prevalence of ALD hyper-response to stress, found in the present study, account for approximately 60% of patients with apparent ESHT expected to respond to MRAs. This figure is close to that of patients responding to eplerenone in the Levy et al study.…”

Section: Discussionmentioning

confidence: 64%

Stress-induced Aldosterone Hyper-Secretion in a Substantial Subset of Patients With Essential Hypertension

Markou

Sertedaki

Kaltsas

et al. 2015

The Journal of Clinical Endocrinology &Amp; Metabolism

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Primary aldosteronism in hypertensive patients: clinical implications and target therapy

Abstract: Using the FDST, an increased prevalence of PA in hypertensives was observed. Α significant blood pressure lowering effect was obtained with MRA treatment, implying that these agents may be beneficial in a significant number of hypertensive patients.

Cited by 22 publications

References 41 publications

PROGRESS IN ALDOSTERONISM: A review of the prevalence of primary aldosteronism in pre-hypertension and hypertension

PROGRESS IN ALDOSTERONISM: A review of the prevalence of primary aldosteronism in pre-hypertension and hypertension

The prevalence of primary aldosteronism (PA) in a group of 350 hypertensive patients

Stress-induced Aldosterone Hyper-Secretion in a Substantial Subset of Patients With Essential Hypertension

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