PROSPECTIVE APPRAISAL ON THE PREVALENCE OF PRIMARY ALDOSTERONISM AND ITS SUTYPES IN HYPERTENSIVE PATIENTS PRESENTING WITH ATRIAL FLUTTER OR FIBRILLATION

Abstract

Objective: Excess aldosterone has been suggested to favour and/or cause atrial fibrillation (AF), particularly in the patients with arterial hypertension, but the relationship between AF and primary aldosteronism (PA) remains uncertain. Hence, we tested the hypothesis that AF is one of the presenting signs of unrecognized PA, and investigated the prevalence of PA and its subtypes in hypertensive patients presenting with lone AF. Design and method: Consecutive patients with an unambiguous diagnosis of arterial hypertension presenting with ECG-confirmed AF and no obvious causes of the arrhythmia were recruited and submitted to the screening and subtyping for PA according to the Endocrine Society PA current guidelines, including measurement of plasma renin activity and aldosterone levels after appropriate pharmacological preparation, and adrenal vein sampling (Funder J. JCEM 2016). The diagnosis of aldosterone-producing adenoma followed the four corner criteria, which imply cure of PA after adrenalectomy (Rossi GP. JACC 2006). Results: From 2015 to 2017, 296 patients (age 76 ± 12 years; 48/52 F/M, %) were recruited in three ESH centers of Excellence for arterial hypertension in Italy (Padua, Brescia and Rome). Fifty-five patients, who met the inclusion criteria and had no exclusion criteria, underwent the entire diagnostic work-up for PA. This allowed to ascertain that the overall prevalence of PA was 34.5%, 42% of the cases being accounted for by aldosterone-producing adenoma and the rest by bilateral forms. Conclusions: By providing compelling evidence for a high prevalence of PA in hypertensive patients presenting with the so-called “lone” AF, these results can lead to changing clinical practice in the management of these patients in that they indicate the need to carefully searching for PA and undertaking subtyping with the aim of pinpointing those who can be cured with unilateral laparoscopic adrenalectomy.