Stroke disclosing primary aldosteronism: Report on three cases and review of the literature

Nasri, Amina; Mansour, Malek; Brahem, Zeineb; Kacem, Amel; Hassan, Ahmed Abou; Derbali, Hajer; Messelmani, Mariem; Zaouali, Jamel; Mrissa, Ridha

doi:10.1016/j.ando.2016.07.993

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…Patients with primary aldosteronism caused by an aldosterone-producing adenoma who underwent unilateral adrenalectomy similarly displayed lower rates of cardiovascular events and stroke. 7,67 Collectively, the evidence informs us that cardiovascular complications can be minimized when primary aldosteronism is effectively treated using targeted therapy that specifically blocks the mineralocorticoid receptor, or adrenal surgery to remove the source of excess aldosterone.…”

Section: Primary Aldosteronism Confers a Higher Stroke Risk Than Bp-m...mentioning

confidence: 99%

Hypertension Management in Stroke Prevention

McCarthy

Yang

Clissold

et al. 2021

Stroke

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Primary aldosteronism confers a higher risk of stroke, atrial fibrillation, and cardiovascular disease than blood pressure matched essential hypertension. It is the most common endocrine cause of secondary hypertension with prevalence estimates of up to 13% in primary care and 30% in referral centers around the world. Unlike essential hypertension, primary aldosteronism has targeted medical treatment and potentially curative surgical solutions which can ameliorate the associated cardiovascular risks. This narrative review highlights an evidence gap in the optimal diagnosis and targeted treatment of primary aldosteronism in secondary stroke prevention. Over half of the patients suffering a stroke have blood pressure in the hypertensive range and less than a third achieve optimal blood pressure control. There are no guideline recommendations to test for primary aldosteronism in these patients, although up to 30% of patients with resistant hypertension may have this disease. The accurate diagnosis of primary aldosteronism could significantly improve blood pressure, simplify the medication regimen and reduce the overall cardiovascular risk in these patients. The challenges associated with screening for primary aldosteronism following stroke may be overcome by novel blood tests which are less affected by antihypertensive medications routinely used in stroke care. Approximately one-quarter of all strokes occur in patients who have previously had a stroke. Modifying hypertension, the leading modifiable risk factor, would, therefore, have significant public health implications. As clinicians, we must increase our awareness of primary aldosteronism in patients with stroke, particularly in those with resistant hypertension, to enable targeted therapy and reduce the risk of stroke recurrence.

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Section: Primary Aldosteronism Confers a Higher Stroke Risk Than Bp-m...mentioning

confidence: 99%

Hypertension Management in Stroke Prevention

McCarthy

Yang

Clissold

et al. 2021

Stroke

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“…PA is a treatable condition, either with curative surgery in the setting of a unilateral aldosterone producing adenoma or mineralocorticoid receptor antagonists (MRA) for bilateral adrenal disease. Targeted treatment leads to lower rates of cardiovascular events and stroke ( 7 , 8 ). Despite the availability of targeted treatment, there is an absence of recommendations to screen for PA in stroke management guidelines ( 9 – 12 ).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of primary aldosteronism in acute stroke or transient ischemic attack: a systematic review and meta-analysis

McCarthy,

Munnings,

Clissold

et al. 2024

Front. Endocrinol.

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Background and purposePrimary aldosteronism (PA) is the most common endocrine cause of secondary hypertension with a prevalence of 14% in patients with newly diagnosed hypertension. Patients with PA experience a higher rate of cardiovascular events including stroke when compared to those with blood pressure matched essential hypertension. This systematic review and meta-analysis summarize current evidence on the prevalence of PA in patients with acute stroke or transient ischemic attack (TIA).MethodsTwo reviewers independently reviewed the literature for observational studies on the prevalence of PA in patients with acute stroke or TIA. MEDLINE and Embase were searched for studies up to December 13, 2023.ResultsThree single center studies conducted in Japan, Singapore and China were found to meet the inclusion criteria. The reported prevalence of PA in two cohort studies of adults with stroke or TIA were 3.1% and 4.0% and a third cross-sectional study in adults under 45 years old revealed a prevalence rate of 12.9%. Following a meta-analysis, the pooled prevalence of PA in adults with stroke or TIA is 5.8% [95% CI 1.6%-12.3%].ConclusionsA considerable proportion of patients with stroke or TIA may have PA as the underlying cause of their hypertension. Given the increased risk of stroke associated with PA, clinicians should consider screening for PA in hypertensive patients with stroke or TIA. Further research is needed to evaluate the effect of timing and interfering medications on test results, which will inform an evidence-based approach to testing for PA following TIA or stroke.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022328644.

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