AbstractPrimary aldosteronism (PA) is the most common endocrine cause of arterial
hypertension. Despite the increasing incidence of hypertension worldwide, the
true prevalence of PA in hypertension was only recently recognized. The
objective of the work was to estimate the prevalence of PA in patients at
different stages of hypertension based on a newly developed screening-diagnostic
overnight test. This is a prospective study with hypertensive patients
(n=265) at stage I (n=100), II (n=88), and III
(n=77) of hypertension. A group of 103 patients with essential
hypertension without PA was used as controls. PA diagnosis was based on a
combined screening-diagnostic overnight test, the
Dexamethasone-Captopril-Valsartan Test (DCVT) that evaluates aldosterone
secretion after pharmaceutical blockade of angiotensin-II and
adrenocorticotropic hormone. DCVT was performed in all participants
independently of the basal aldosterone to renin ratio (ARR). The calculated
upper normal limits for post-DCVT aldosterone levels [3 ng/dl (85
pmol/l)] and post-DCVT ARR [0.32
ng/dl/μU/ml (9 pmol/IU)] from controls,
were applied together to establish PA diagnosis. Using these criteria PA was
confirmed in 80 of 265 (30%) hypertensives. The prevalence of PA was:
21% (21/100) in stage I, 33% (29/88) in stage
II, and 39% (30/77) in stage III. Serum K+
levels were negatively correlated and urinary K+ was
positively correlated in PA patients with post-DCVT ARR
(r=–0.349, p <0.01, and r=0.27, p <0.05
respectively). In conclusion, DCVT revealed that PA is a highly prevalent cause
of hypertension. DCVT could be employed as a diagnostic tool in all subjects
with arterial hypertension of unknown cause.
Prevalence of Primary Aldosteronism among Unselected Hypertensive Patients: A Prospective Study Based on the Use of an Aldosterone/Renin Ratio above 25 as a Screening Test
