Should all Hypertensive Patients be Screened for Primary Aldosteronism?

Abstract

Our aim was to determine whether the prevalence of Primary Aldosteronism (PA) in a referral hypertensive population is high enough to warrant routine screening for PA amongst unselected hypertensive’s in general practice. A retrospective clinical audit was conducted on 635 patients referred for specialist hypertension review, over a period of 33 months (March 2009 till December 2011). We found a PA prevalence of (confirmed or probable) in 8/635 referred patients (1.25%) which is lower that the previously reported prevalence. Among the 178 patients who at discharge had met the JNC-7 criteria for resistant hypertension the prevalence was 4.5% (8/178). All the PA cases met the criteria for resistant hypertension, and in addition, all had unprovoked hypokalaemia. We conclude that in our population, routine screening for PA amongst hypertensive individuals in general practice cannot be justified, and that even in a specialist hypertension clinic population investigation should likely be reserved for those with a combination of resistant hypertension and unprovoked hypokalaemia.