The Unrecognized Prevalence of Primary Aldosteronism

Brown, Jenifer M; Siddiqui, Mohammed; Calhoun, David A.; Carey, Robert M.; Hopkins, Paul N.; Williams, Gordon H.; Vaidya, Anand

doi:10.7326/m20-0065

Cited by 334 publications

(259 citation statements)

References 64 publications

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“…3.76-90.10, p < 0.0001). Similar results were reported in recent studies by Baudrant et al and Brown et al where autonomous aldosterone secretion was detected in 14 and 11 % respectively of normotensive populations [39,40]. These data suggest the adoption of strict selection criteria for any control group used to define normal cut-offs for PA, by recruiting individuals with long-standing normal BP and normal adrenal imaging.…”

Section: Normotensive Controls Recruitmentsupporting

confidence: 90%

Five Reasons for the Failure to Diagnose Aldosterone Excess in Hypertension

et al. 2020

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Primary hyperaldosteronism (PA) is a well-known cause of hypertension although its exact prevalence amongst patients with apparent essential hypertension has been a matter of debate. A number of recent studies have suggested that mild forms of PA may be relatively common taking into consideration factors that were previously either overestimated or ignored when developing diagnostic tests of PA and when applying these tests into normotensive individuals. The performance characteristics and diagnostic accuracy of such tests are substantially increased when the adrenocorticotrophin effect, inappropriate potassium levels and their application in carefully selected normotensive individuals are considered. In the present review, we critically analyze these issues and provide evidence that several, particularly mild, forms of PA can be effectively identified exhibiting potentially important clinical implications.

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Section: Normotensive Controls Recruitmentsupporting

confidence: 90%

Five Reasons for the Failure to Diagnose Aldosterone Excess in Hypertension

et al. 2020

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“…However, the prevalence of resistant hypertension in PA and EH patients was similar, which made it less likely to be a confounder. It was very recently well-shown that PA could be unrecognized among patients with EH and that confirmatory tests, such as an oral sodium suppression test, should be performed before formally diagnosing EH ( 42 ); we must stress that the overwhelming majority of patients included in our study had confirmatory tests to diagnose or exclude PA. There was no control group without hypertension, which did not allow us to compare the prevalence of MetS in PA patients to that in the normal non-hypertensive population; however, this was not the objective of our study.…”

Section: Discussionmentioning

confidence: 94%

Associations Between Metabolic Profiles and Target-Organ Damage in Chinese Individuals With Primary Aldosteronism

et al. 2020

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Purpose: Patients with primary aldosteronism (PA) have an increased risk of target-organ damage (TOD), but whether metabolic syndrome (MetS) is more prevalent and contributes to TOD in PA patients remains unresolved. We aimed to evaluate the associations between MetS profiles and TOD in Chinese PA individuals. Methods: Metabolic parameters and pre-clinical TOD including left ventricular hypertrophy, estimated glomerular filtration, and microalbuminuria; insulin sensitivity or resistance; and islet β-cell function were assessed by the homeostasis models (HOMA-IR, HOMA-β) and the other surrogate indexes [composite insulin sensitivity index (ISI), modified β-cell function index (MBCI)] determined from the oral glucose tolerance test were compared in PA vs. matched essential hypertension (EH) patients. Results: A total of 109 PA patients and 109 essential hypertension (EH) controls individually matched for sex, age, and office systolic blood pressure and duration of hypertension were studied. The prevalence of MetS and its individual components in PA was significantly lower than in EH [MetS: 28 (25.6%) vs. 54 (49.5%), P < 0.001]. PA patients had a higher composite ISI but a lower HOMA-IR, HOMA-β, and MBCI than EH controls (all P < 0.05). Concerning TOD, PA patients had significantly higher prevalence of microalbuminuria and left ventricular hypertrophy (LVH), and lower levels of estimated glomerular filtration (eGFR) than EH controls (all P < 0.05). On multivariate logistic regression analysis, female gender and elevated plasma aldosterone levels were significantly associated with TOD in PA. However, there were no significant associations between MetS and its individual components and TOD in PA patients. Conclusions: PA patients had a lower MetS prevalence but exhibited more severe TOD than matched EH controls. The study highlights the deleterious effects of aldosterone excess on the development of TOD, whereas MetS or its individual components might be less influential in PA.

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“…With systematic screening, including aldosterone-to-renin ratios, hyperaldosteronism is prevalent among individuals within stage 1 (16%) or stage 2 (22%) hypertension, compared with normotensive individuals (11%). 24 It is not cost-effective to perform a workup for secondary causes of hypertension in all pregnant women or all adults outside pregnancy. However, it is considered prudent to perform a basic workup in early pregnancy if not performed before pregnancy.…”

Section: Definitionmentioning

confidence: 99%