Prevalence of Primary Aldosteronism Across the Stages of Hypertension Based on a New Combined Overnight Test

2021 ◽  
Vol 53 (07) ◽  
pp. 461-469
Author(s):  
Nick Voulgaris ◽  
Ernestini Tyfoxylou ◽  
Sophia Vlachou ◽  
Evagelia Kyriazi ◽  
Chris Gravvanis ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Primary Aldosteronism ◽  
Adrenocorticotropic Hormone ◽  
Stage I ◽  
Aldosterone Secretion ◽  
Hypertensive Patients ◽  
True Prevalence ◽  
Normal Limits ◽  
Aldosterone To Renin Ratio ◽  
A Prospective Study

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.

Evaluation of Biochemical Conditions Allowing Bypass of Confirmatory Testing in The Workup of Primary Aldosteronism: A Retrospective Study in a French Hypertensive Population

2019 ◽  
Vol 51 (03) ◽  
pp. 172-177 ◽  
Author(s):  
Maud Vivien ◽  
Emilie Deberles ◽  
Remy Morello ◽  
Aimi Haddouche ◽  
David Guenet ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Dynamic Testing ◽  
Challenge Test ◽  
Plasma Aldosterone ◽  
Aldosterone Secretion ◽  
Plasma Aldosterone Concentration ◽  
Hypertensive Patients ◽  
Hypertensive Population ◽  
Tertiary Center ◽  
Aldosterone To Renin Ratio

AbstractThe diagnostic workup for primary aldosteronism includes a screening step using the aldosterone-to-renin ratio (ARR) and a confirmatory step based on dynamic testing of aldosterone secretion autonomy. International guidelines suggest that precise clinical and biochemical conditions may allow the bypassing of the confirmatory step, however, data which validate hormone thresholds defining such conditions are lacking. At our tertiary center, we retrospectively examined a cohort of 173 hypertensive patients screened for PA by the ARR, of whom 120 had positive screening and passed a saline infusion test (SIT) or a captopril challenge test (CCT). Fifty-nine had PA, including 34 Conn adenomas and 25 with idiopathic aldosteronism (IA). Using a threshold of 160 pmol/l, post-SIT plasma aldosterone concentration (PAC) identified PA with 86.4% sensitivity, 94.7% specificity, and a negative predictive value of 92.3%. Of those subjects with a high ARR and a PAC above 550 pmol/l, 93% had a positive SIT, while 100% of subjects with a high ARR, but a PAC under 240 pmol/l had a negative SIT. Our results thus validate the biochemical conditions defined in the French and US guidelines for bypassing the confirmatory step in the workup for PA diagnosis.

scholarly journals Aldosterone to Renin Ratio as Screening Tool in Primary Aldosteronism

2018 ◽  
Vol 127 (02/03) ◽  
pp. 84-92
Author(s):  
Katharina Schilbach ◽  
Riia Junnila ◽  
Martin Bidlingmaier
Keyword(s):  
Primary Aldosteronism ◽  
Screening Test ◽  
Screening Tool ◽  
Secondary Hypertension ◽  
Hypertensive Patients ◽  
Assay Methods ◽  
Aldosterone To Renin Ratio

AbstractPrimary aldosteronism (PA) is a severe and often underdiagnosed form of secondary hypertension. Determining the aldosterone to renin ratio (ARR) in hypertensive patients has been shown to be a valuable screening test for identification of patients suffering from PA. Since the introduction of a more widespread ARR screening the number of PA patients significantly increased worldwide. Interpretation of ARR might be challenging: Several factors from posture to interfering drugs affect the ARR and need to be taken into account when collecting samples. In addition, the wide variety of available assay methods and lack of well-established cut-offs present a challenge to the clinician. This review discusses the usefulness and possible difficulties of ARR screening.

scholarly journals Would wider screening for primary aldosteronism give any health benefits?

2004 ◽  
pp. 305-308 ◽  
Author(s):  
PF Plouin ◽  
X Jeunemaitre
Keyword(s):  
Primary Aldosteronism ◽  
Clinical Syndrome ◽  
Hypertensive Patients ◽  
The Past ◽  
Apparent Prevalence ◽  
In Series ◽  
Aldosterone Producing Adenoma ◽  
Aldosterone To Renin Ratio ◽  
Referral Bias ◽  
Adrenocortical Tumour

Fifty years ago, Jerome Conn described 'a new clinical syndrome which is designated temporarily as primary aldosteronism' in a young patient with hypertension, severe hypokalaemia and a benign adrenocortical tumour, for whom an adrenalectomy cured both the hypertension and hypokalaemia. His report identified the condition known as aldosterone-producing adenoma, a form of curable hypertension. According to Conn, the prevalence of primary aldosteronism in the hypertensive population referred to his department was 20%, but this estimate was subject to referral bias. Primary aldosteronism has long been considered rare, with an estimated prevalence of 0.5-2% among unselected hypertensive patients. During the past 10 years, however, the apparent prevalence of the condition increased dramatically, up to 30% in some series. Overall, the prevalence of primary aldosteronism in series dealing with at least 100 screened hypertensive patients averaged 6%, with one patient in two harbouring an aldosterone-producing adenoma. This increase in prevalence reflects the fact that hypokalaemic and normokalaemic patients are now screened for primary aldosteronism, with the aldosterone to renin ratio used as a screening tool. The current 'epidemic' of primary aldosteronism raises several questions and concerns.

scholarly journals A Prospective Study of the Prevalence of Primary Aldosteronism in 1,125 Hypertensive Patients

2006 ◽  
Vol 48 (11) ◽  
pp. 2293-2300 ◽  
Author(s):  
Gian Paolo Rossi ◽  
Giampaolo Bernini ◽  
Chiara Caliumi ◽  
Giovambattista Desideri ◽  
Bruno Fabris ◽  
...  
Keyword(s):  
Prospective Study ◽  
Primary Aldosteronism ◽  
Hypertensive Patients ◽  
A Prospective Study

scholarly journals Progress in Primary Aldosteronism 2019: New Players on the Block?

2020 ◽  
Vol 52 (06) ◽  
pp. 345-346 ◽  
Author(s):  
Martin Reincke ◽  
Felix Beuschlein ◽  
Tracy Ann Williams
Keyword(s):  
Resistant Hypertension ◽  
Primary Aldosteronism ◽  
Retrospective Cohort ◽  
Plasma Renin ◽  
Epidemiological Data ◽  
Screening Rate ◽  
Aldosterone Secretion ◽  
Endocrine Hypertension ◽  
High Prevalence ◽  
Aldosterone To Renin Ratio

Primary aldosteronism (PA) is characterized by hypertension caused by inappropriately high adrenal aldosterone secretion, consecutively low plasma renin, and an elevated aldosterone to renin ratio. It is nowadays the universally accepted main cause of endocrine hypertension. According to the most recent epidemiological data, PA is present in 5.8% of unselected hypertensives in primary care, 6–12% of hypertensives treated in hypertension centers, and up to 30% in subjects with resistant hypertension 1. Despite this high prevalence, a recent survey demonstrated that screening for PA is not universally followed. Renin and aldosterone measurements, the basis for PA screening, are currently performed by only 7% of general practitioners in Italy and 8% in Germany 2. Accordingly, the prevalence of PA was low with 1% among hypertensives in Italy and 2% in Germany. In a retrospective cohort study of 4660 patients with resistant hypertension in California the screening rate for PA was 2.1% 3. Based on these data, it is clear that we still miss the majority of PA cases, despite advances in diagnosis and therapy.

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