The prevalence of primary aldosteronism (PA) in a group of 350 hypertensive patients

Abstract

Background Hypertension is one of the commonest diseases worldwide. Its prevalence is estimated to approximately 25% of the population. In addition, hypertension is an important risk factor for increased cardiovascular events. In most cases it is of idiopathic origin, but may also be due to another disease, e.g. endocrine dysfunction. Primary aldosteronism (PA) is a common cause of resistant hypertension; its proper diagnosis determines further therapy. The aim of this study was to evaluate the prevalence of PA in a group of 350 patients (240 women and 110 men) with hypertension. Material and methods All patients underwent hormonal tests including assessment of the levels of: ACTH, cortisol (baseline and in dexamethasone suppression test), DHEA-S, chromogranin A, VMA urine excretion, aldosterone and active renin. Afterwards, an intravenous load test with 0.9% neutral saline solution was performed. Abdominal ultrasound was performed in all patients, and abdominal computed tomography only in patients with abnormal hormonal tests. Other forms of secondary hypertension were previously excluded. Results Primary aldosteronism was diagnosed in 58 patients (16.6%) — 38 women and 20 men. Adrenal adenoma was found in 20 patients (34.5%), and idiopathic hyperaldosteronism in 38 patients (65.5%). Hypokalaemia occurred in 25 patients (43.1%). Moreover, it was found that the aldosterone-renin ratio above 8.25 supports the diagnosis of PA. Conclusion We conclude that the diagnosis of PA should not be limited only to the hypertensive patient with hypokalaemia. PA is an important cause of hypertension, especially among patients with difficulties in normalization of blood pressure with standard pharmacological treatment.