Testing for Primary Hyperaldosteronism in Resistant Essential Hypertensive Patients

Abstract

Background: Hypertension is a common condition that affects many people all over the world. It could be associated with several complications especially in cases of resistant hypertension. Many clinical practice guidelines recommend screening for primary aldosteronism especially in persons with resistant hypertension owing to the worse prognosis when compared with blood pressure-matched essential hypertension. Objective: The study aimed to screen for primary aldosteronism in high-risk hypertensive Egyptian patients, and to determine the challenges faced in the diagnosis. Material and methods: 50 high-risk hypertensive patients were recruited from the Outpatient Endocrinology Clinic out of 200 hypertensive patients in the period from February 2019 and April 2021. Creatinine, Glycosylated hemoglobin (HBA1c), lipid profile, potassium level, sodium level, Plasma Aldosterone Concentration (PAC), Active Renin Concentration (ARC), and aldosterone/ Renin Ratio (ARR) were assessed in all patients. Results: A series of 50 hypertensive patients screened for PA (26 females and 24 males) with a mean age of 41.88±11.91 SD. We found that 41(82%) patients were receiving antihypertensive medications and 9(18%) patients didn’t receive treatment for hypertension previously. 9(18%) patients kept on no treatment, 6(12%) patients were kept on the same anti-hypertensive medications, and 35(70%) of them were shifted to other anti-hypertensive drugs. 4 patients out of total 50 patients had a positive ARR (>46), while 13(26%) patients out of total 50 hypertensive patients had low renin levels. There was a statistically significant relation between serum Aldosterone/ Renin Ratio (ARR) and serum Potassium (K) with P-value=0.001 (Figure 4), also a statistically significant relation between serum aldosterone/ renin ratio (ARR) and (systolic blood pressure, diastolic blood pressure) with P-value=0.001 was found. Conclusion: We recommend routine screening for PA in high-risk hypertensive patients that could offer targeted treatment before adverse cardiovascular consequences develop.