Primary aldosteronism in patients with acute stroke: prevalence and diagnosis during initial hospitalization.

Kentaro Mori,Hiroshi Shima,Yuichi Kawabata,Shunsuke Seki,Taichi Minami,Masayo Yamada,Akira Tamase,Mayuko Sasaki,Hirotatsu Nakaguchi,Hideto Joki,Motohiro Nomura,Yoshihisa Kitamura,Tetsuji Tsunoda,Yosuke Miyaji,Fumiaki Tanaka,Tomoya Kamide

doi:10.1186/s12883-016-0701-5

Abstract

BackgroundHypertension is the prime risk factor for stroke, and primary aldosteronism (PA) is the most common cause of secondary hypertension. The prevalence of PA in stroke patients has never been reported. The aim of this study was to elucidate the prevalence of PA.MethodsA total of 427 consecutive patients with acute stroke were prospectively enrolled for this study. The screening tests were performed at the initial visit and a week after admission by measuring plasma aldosterone concentration and plasma renin activity. The rapid adrenocorticotropic hormone (ACTH) test was performed as the confirmatory test when both screening tests were positive. The primary endpoint was a final diagnosis of PA.ResultsThe sensitivity of the dual screening system for the diagnosis of PA was 88.2 %, and PA was finally diagnosed in 4.0 % of acute stroke patients and in 4.9 % of stroke patients with a history of hypertension. Patients with PA were less likely to be male and have diabetes, and they had higher blood pressure at the initial visit, lower potassium concentration, and more intracerebral hemorrhage. The rapid ACTH test was performed safely even in acute stroke patients.ConclusionsThe prevalence of PA is not low among acute stroke patients. Efficient screening of PA should be performed particularly for patients with risk factors.Trial registrationUMIN-CTR; UMIN000011021. Trial registration date: June 23, 2013 (retrospectively registered).

Highlights

Hypertension is the prime risk factor for stroke, and primary aldosteronism (PA) is the most common cause of secondary hypertension
Study population Consecutive patients with acute stroke including transient ischemic attack (TIA) who were admitted to Yokohama Sakae Kyosai Hospital between April 2013 and March 2014 were prospectively enrolled for this study
We found no significant differences in ischemic stroke subtypes between patients with and without PA, all cardioembolic strokes were based on non-valvular atrial fibrillation and the culprit artery for atherothrombotic stroke was the internal carotid artery in PA patients

Summary

Introduction

Hypertension is the prime risk factor for stroke, and primary aldosteronism (PA) is the most common cause of secondary hypertension. The prevalence of PA in stroke patients has never been reported. Hypertension is the prime risk factor for stroke [1], and treatment of hypertension is highly effective in the prevention of stroke [2, 3]. Secondary hypertension is identified in a relatively small proportion of adult patients with hypertension. Most PA patients are successfully treated by unilateral adrenalectomy or with mineralocorticoid receptor antagonists [12, 13], and the blood pressure becomes normalized [14, 15]. Some reports have demonstrated improvement of left ventricular hypertrophy, renal function, and the cardiovascular prognosis with PA treatment [16,17,18]

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