Prevalence Of Primary Aldosteronism In Patients Research Articles

Prevalence of primary aldosteronism in acute stroke or transient ischemic attack: a systematic review and meta-analysis.

Primary aldosteronism (PA) is the most common endocrine cause of secondary hypertension with a prevalence of 14% in patients with newly diagnosed hypertension. Patients with PA experience a higher rate of cardiovascular events including stroke when compared to those with blood pressure matched essential hypertension. This systematic review and meta-analysis summarize current evidence on the prevalence of PA in patients with acute stroke or transient ischemic attack (TIA). Two reviewers independently reviewed the literature for observational studies on the prevalence of PA in patients with acute stroke or TIA. MEDLINE and Embase were searched for studies up to December 13, 2023. Three single center studies conducted in Japan, Singapore and China were found to meet the inclusion criteria. The reported prevalence of PA in two cohort studies of adults with stroke or TIA were 3.1% and 4.0% and a third cross-sectional study in adults under 45 years old revealed a prevalence rate of 12.9%. Following a meta-analysis, the pooled prevalence of PA in adults with stroke or TIA is 5.8% [95% CI 1.6%-12.3%]. A considerable proportion of patients with stroke or TIA may have PA as the underlying cause of their hypertension. Given the increased risk of stroke associated with PA, clinicians should consider screening for PA in hypertensive patients with stroke or TIA. Further research is needed to evaluate the effect of timing and interfering medications on test results, which will inform an evidence-based approach to testing for PA following TIA or stroke. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022328644.

PREVALENCE OF PRIMARY ALDOSTERONISM AND HYPOKALEMIA IN 5,100 PATIENTS REFERRED TO A TERTIARY HYPERTENSION UNIT

Objective: Primary aldosteronism (PA) was considered a rare disorder almost always associated with hypokalemia. After the introduction of aldosterone-to-renin ratio, the widespread screening of hypertensive patients unveiled a higher prevalence of normokalemic PA, which now represents the prevailing phenotype. Many studies have described the prevalence of hypokalemia in patients with PA, conversely the prevalence of PA in patients with hypokalemia is unknown. In this retrospective observational study, we define the prevalence of hypokalemia in referred patients with hypertension and the prevalence of PA in patients with hypokalemia and hypertension. Design and method: For each patient, medical records were reviewed by three independent reviewers, who were blinded to patients’ identification and diagnosis. Hypokalemia was defined for potassium levels lower than 3.7 mmol/L. PA was diagnosed according to the Endocrine Society guideline. Multivariate logistic regression analysis was used to assess the association of hypokalemia and PA with cardiovascular risk indicators. Results: Hypokalemia was present in 15.8% of 5,100 patients with hypertension whereas 76.9% of these patients were normokalemic. PA prevalence in this cohort was significantly higher than in a cohort of 1,672 unselected patients with hypertension in primary care from the PATO study (7.8% vs. 5.9%, P = 0.011). The prevalence of PA in patients with hypokalemia was 28.1% and increased with decreasing serum potassium concentrations up to 88.5% of patients with spontaneous hypokalemia and serum potassium concentrations below 2.5 mmol/L. A multivariate regression analysis demonstrated the association of hypokalemia with the occurrence of cardiovascular events independent of PA diagnosis. An association of PA with the occurrence of cardiovascular events and target organ damage independent of hypokalemia was also demonstrated. Conclusions: Our results confirm that PA is a frequent cause of secondary hypertension in patients with hypokalemia and the presence of hypertension and spontaneous hypokalemia are strong indications for a diagnosis of PA. Finally, we show that PA and hypokalemia are associated with an increased risk of cardiovascular events.

OBSTRUCTIVE SLEEP APNEA AND PRIMARY ALDOSTERONISM: A MULTICENTER CROSS-SECTIONAL STUDY

Objective: 2016 Endocrine Society guideline recommends screening for primary aldosteronism (PA) all patients with hypertension and obstructive sleep apnea (OSA), despite evidences supporting this recommendation are limited. We designed a multi-ethnic, multicentre, cross-sectional study to assess the prevalence of PA in patients with OSA and the prevalence of OSA in unselected patients with PA. Design and method: 203 patients with OSA (101 Chinese and 102 of Caucasian ethnicity) were screened for PA, followed by confirmatory test and subtyping diagnosis in case of confirmed PA. 207 patients with PA (104 Caucasians, 100 Chinese and 3 of African descent) were tested by cardio-respiratory polygraphy for OSA diagnosis. Results: The prevalence of PA in patients with OSA was 8.9% (11.8% in Caucasian and 5.9% in Chinese patients). Among patients without other indications for PA screening beyond OSA diagnosis, the prevalence of PA was very low (1.5%). The prevalence of OSA in patients with PA was 67.6% (64.4% in Caucasians, 70.0% in Chinese ethnicity). We observed a significant correlation between serum aldosterone levels and apnea/hypopnea index in Caucasian patients with PA (R2 = 0.360, p = 0.013), but not in the Chinese patients with PA. In the Caucasian group with PA, multinomial logistic regression confirmed a significant association between aldosterone levels and moderate-severe OSA (OR 1.002, p = 0.002), but no association was present in the Chinese group. Conclusions: Patients with OSA do not display a higher risk of PA, challenging the Endocrine Society guideline recommendation of screening all patients with OSA for PA, irrespective of the grade of hypertension. However, OSA is a frequent condition in patients with PA and aldosterone level can contribute to OSA severity in patients with PA of Caucasian ethnicity.

DRUG-RESISTANT HYPERTENSION IN PRIMARY ALDOSTERONISM

Objective: Drug-resistant arterial hypertension can derive from unrecognized forms of secondary hypertension of which primary aldosteronism (PA) is one of the most common. While available data suggest a high prevalence of PA in patients with resistant hypertension (RH), its rate in such population is unclear. This study sought to establish the rate of RH in patients with PA and the blood pressure outcome and resistance to treatment after adrenalectomy PA-RH patients subtyped by adrenal vein sampling (AVS). Design and method: Data from consecutive patients with unambiguous diagnosis of PA and seeking surgical cure, submitted to AVS in 19 tertiary referral centers located in Asia, Australia, Europe, and North America, were collected in an observational prospective registry from 2000 to 2015. Blood pressure outcome and resistance to treatment by the American Heart Association 2018 criteria or a local clinical definition were the main study outcomes. Inclusion criteria were age > 18 years, indication to perform AVS following current guidelines, center's agreement to participate and approval of the local Ethics Committee. Results: Of 1625 enrolled PA patients, 73.7% had conclusive information on presence or absence of resistant hypertension. Of these, 20.1% were judged to have RH, a rate that raised to 49.5% according to the clinical definition of each center lead investigator. RH was about twice as common in men as in women (p < 1x10-4). Fifty-three percent of the PA patients with RH underwent surgery, which resolved resistance to drug treatment in all. Conclusions: RH is a common presentation of PA in consecutive patients seeking surgical cure; AVS-guided adrenalectomy allowed to resolve resistance of high blood pressure to treatment. Hence, the optimal management of patients with PA and RH requires subtyping with adrenal vein sampling.

High prevalence and a long delay in the diagnosis of primary aldosteronism among patients with young-onset hypertension.

Despite being the most common cause of secondary hypertension, prevalence of primary aldosteronism (PA) among patients with young-onset hypertension (YH - age of hypertension onset <40 years) remains poorly studied. We assessed the prevalence of PA in patients with YH referred for evaluation of secondary hypertension. In this prospective, cross-sectional study, 202 patients with YH, visiting endocrine and cardiology clinics of All India Institute of Medical Sciences, India, were evaluated. Primary aldosteronism was screened by measuring plasma aldosterone concentration (PAC) and direct renin concentration (DRC) and calculating aldosterone-to-renin ratio (ARR), followed by confirmatory saline infusion test (SIT) according to Endocrine Society Guideline. Those confirmed with post-SIT PAC >5ng/dl underwent adrenal computed tomography (CT), followed by adrenal venous sampling (AVS). Of 202 YH patients, 38 (18.8%) screened positive, and PA was confirmed in 36 (17.8%). The mean age was 43.9±10.9years, and median duration of hypertension was 10.5 (3.5-18) years. The prevalence of PA increased with grade of hypertension (8.1% in grade 1 to 37.1% in grade 3), number of antihypertensive medications (2.5% in those taking ≤1 to 50% in those taking ≥4 medications) and severity of hypokalaemia (0% in potassium >5 to 85.7% in potassium <3.5mmol/L). The prevalence of PA by age of hypertension onset was highest in age group 30-39years (31.3%). There is a high prevalence and a long delay in diagnosis of PA among patients with YH, and YH should be considered as a separate high-risk category in PA screening algorithm.

Hypertension Editors' Picks: Hyperaldosteronism.

Hypertension Editors' Picks: Hyperaldosteronism.

MON-211 Prevalence, Characteristics and Outcomes of Primary Aldosteronism in Newly Diagnosed Hypertensives in China (Pa China)

Background 44.7% adults in China have hypertension but the prevalence of primary aldosteronism (PA) in Chinese hypertensives is unknown. Objective We prospectively investigated the prevalence of PA in newly diagnosed hypertensives and tested the hypothesis that these PA patients have less severe cardiovascular complications and better outcomes when compared to those diagnosed after established (or prolonged) hypertension. Method In a community health center, consecutive hypertensive patients with an aldosterone-renin ratio≥2 (ng∙dL−1/mIU∙L−1) and plasma aldosterone concentration >10ng/dL underwent captopril challenge test and/or saline infusion test for confirmation. Adrenal CT scan and adrenal vein sampling were used for subtyping. PA patients were followed up for one year and clinical outcomes were compared with PA patients from an established hypertensive cohort. Results 1020 newly diagnosed hypertensive patients were screened over 16 months. Forty were diagnosed with PA, 948 with non-PA, resulting in a prevalence of 4.0%. Thirty-two patients were diagnosed as “possible PA” due to positive screening but failure to complete the confirmatory test. Compared to non-PA, PA patients more frequently displayed microalbuminuria (P=0.031), but the incidence of cardiovascular events was not different (P=0.927). For patients treated with surgery, complete clinical success rate was 85.7%, 28% higher than that of PA patients diagnosed after prolonged hypertension. For patients treated with medication, blood pressure control rate was 79.3%, 30% higher than that of PA patients diagnosed after prolonged hypertension. Conclusions The prevalence of PA in patients with newly diagnosed hypertension in China was at least 4.0%. PA screening in newly diagnosed hypertensive patients can lead to better clinical outcomes.

Primary Aldosteronism in Patients in China With Recently Detected Hypertension

BackgroundA total of 44.7% adults in China have hypertension, but the prevalence of primary aldosteronism (PA) in Chinese hypertensive patients is unknown. ObjectivesThis study prospectively investigated the prevalence, characteristics, and outcomes of PA in newly diagnosed hypertensive patients. MethodsIn a large community health center, consecutive hypertensive patients with an aldosterone-renin ratio >20 ng/mIU and plasma aldosterone concentration >10 ng/dl underwent captopril challenge test and/or saline infusion test for confirmation of PA. Adrenal computed tomography scan and adrenal vein sampling were used for subtyping. PA patients treated with surgery or medication were followed up for 1 year, and outcomes after treatment were evaluated. ResultsIn total, 1,020 newly diagnosed hypertensive patients were screened over 16 months, of whom 40 were diagnosed with PA, 948 with non-PA, 32 with probable PA, resulting in a prevalence of more than 4.0%. Compared with non-PA, PA patients more frequently displayed microalbuminuria (p = 0.031), but the incidence of cardiovascular events was not different (p = 0.927). For surgically treated patients (n = 7), a complete biochemical success rate was 100% and a complete clinical success rate was 85.7%. For medically treated patients (n = 29), the proportion with optimal blood pressure control was 79%, and among them, 91% (21 of 23) only needed 1 antihypertensive drug: the mineralocorticoid receptor antagonist. ConclusionsThe prevalence of PA in patients with newly diagnosed hypertension in China was at least 4%. PA screening in newly diagnosed hypertensive patients leads to good clinical outcomes. (Primary Aldosteronism In Hypertensive Patients in China [PA-China]; NCT03155139)

Primary aldosteronism in young adults with acute stroke: Prevalence and clinical characteristics

Primary aldosteronism (PA) is notably an independent risk factor for cerebral vascular disease but currently with limited knowledge among young adults. The objectives of the study were to investigate the prevalence of PA in patients under 45 years old with history of acute stroke and the clinical characteristics during stroke attack. We retrieved the medical records of 116 patients once admitted due to acute stroke and cross-sectionally conducted screening test as well as confirmatory test among those patients. An estimated prevalence of PA was 12.7% among all patients and 21.2% among patients combined with hypertension. During stroke attack, PA patients had experienced higher blood pressure as well as decreased potassium level. The average SBP and DBP of PA patients were 180.0 ± 30.9 and 125.9 ± 24.5 mmHg respectively, both remarkably higher than those without PA(mean SBP 148.9 ± 29.6 mmHg, mean DBP94.1 ± 20.5 mmHg). The mean potassium level was 3.13 ± 0.50 vs. 4.01 ± 0.40 mmol/l. The proportion of hypertension and hypokalemia were also increased for PA patients compared with patients without (hypertension 93.3% vs. 51.5%; hypokalemia 80% vs. 8.9%). Patients were equal in National Institutes of Health Stroke Scale (NIHSS) score as well as Glasgow Coma Score (GCS) and stroke subtypes. Considering the fact that excessive aldosterone had detrimental role on cerebral vascular system, we recommend a more rigorous screening for PA with stroke onset under 45 years old, especially those combined with severe hypertension as well as overt hypokalemia.

Determining the Prevalence of Primary Aldosteronism in Patients With New-Onset Type 2 Diabetes and Hypertension

Despite a high prevalence of hypertension in diabetes and close relationship between primary aldosteronism (PA) and glucose metabolism, few study concerns the prevalence of PA in diabetes with hypertension. This study aimed to detect the prevalence of PA in patients with new-onset type 2 diabetes (T2D) and hypertension and to explore the association between PA and diabetes. A total of 256 outpatients with new-onset T2D and hypertension were screened for PA. Plasma aldosterone concentration (PAC), plasma renin activity (PRA) were measured. Patients with an aldosterone renin activity ratio (ARR) ≥ 30 ng/dL/ng/mL/h and PAC ≥ 15 ng/dL underwent confirmatory captopril challenge test (CCT) for PA. The diagnostic criteria for PA were, after CCT, (1) PAC decreased < 30%, (2) ARR maintained ≥ 30 ng/dL/ng/mL/h, and (3) PAC was ≥ 11 ng/dL. Of 256 consecutive patients, 99 (39%) were positive for the screening test, and 49 (19%) were diagnosed with PA. Compared with those in groups A (screening test -) and B (screening test +, CCT -), patients in group C (diagnosed with PA) had a higher percentage of systolic blood pressure of ≥ 160 mmHg, less family history of hypertension, and lower serum potassium. Patients in group B and C had higher PAC and ARR levels, but lower PRA than those in group A. Homeostatic model assessment for insulin resistance (HOMA-IR) was positively associated with PAC level among the diabetic patients. The prevalence of PA in new-onset T2D patients with hypertension is at least 19%. Higher aldosterone may be related with insulin resistance in patients with diabetes.

Prevalence of Hypokalemia and Primary Aldosteronism in 5100 Patients Referred to a Tertiary Hypertension Unit.

Primary aldosteronism (PA) was considered a rare disorder almost always associated with hypokalemia. The widespread screening of patients with hypertension unveiled an increased prevalence of PA with normokalemic hypertension the prevailing phenotype. Many studies have reported the prevalence of hypokalemia in patients with PA; conversely, the prevalence of PA in patients with hypokalemia is unknown. In this retrospective observational study, we define the prevalence of hypokalemia in referred patients with hypertension and the prevalence of PA in patients with hypokalemia and hypertension. Hypokalemia was present in 15.8% of 5100 patients with hypertension, whereas 76.9% were normokalemic, and 7.3% hyperkalemic. The prevalence of PA in patients with hypokalemia was 28.1% and increased with decreasing potassium concentrations up to 88.5% of patients with spontaneous hypokalemia and potassium concentrations <2.5 mmol/L. A multivariate regression analysis demonstrated the association of hypokalemia with the occurrence of cardiovascular events independent of PA diagnosis. An association of PA with the occurrence of cardiovascular events and target organ damage independent of hypokalemia was also demonstrated. In conclusion, our results confirm that PA is a frequent cause of secondary hypertension in patients with hypokalemia, and the presence of hypertension and spontaneous hypokalemia are strong indications for PA diagnosis. Finally, we show that PA and hypokalemia are associated with an increased risk of cardiovascular events.

Abstract P398: Screening of Primary Aldosteronism by Clinical Features and Daily Laboratory Tests: Combination of Urine pH, Sex, and Serum K +

Introduction: There is a clinical need for an easy-to-use method to determine who should be screened for primary aldosteronism (PA). Objective: The aim of our study is to develop and validate a scoring system from clinical features and daily laboratory tests to select patients who should proceed to endocrinolgic examinations of PA from newly diagnosed hypertensives. Methods: A multivariate logistic regression analysis which entered possible PA markers, age &lt; 40 years, female sex, moderate to severe hypertension, hypokalemia, serum Na + minus Cl - ≥ 40 mmol/L, serum uric acid ≤ 237.92 μmol/L (4.0 mg/dL), and urine pH (U-pH) ≥ 7.0 were undertaken in consecutive outpatients newly diagnosed hypertension. The diagnosis of PA was made by plasma aldosterone concentration-to-plasma renin activity ratio (ARR) ≥ 20 and at least one positive result in challenge tests. Results: In derivation study, 24 of 130 patients were diagnosed PA. The area under the receiver operating characteristic curve (AUC) for a logistic model incorporating all possible PA markers was 0.73 (95% CI: 0.61-0.85). Removing high U-pH, female sex, and hypokalemia from the full model decreased the AUC by 0.059, 0.035, and 0.011, respectively. We devised the diagnostic score for predicting possible PA, in which one point each was assigned to high U-pH, female sex and hypokalemia, and named it PFK score. The prevalence of PA in patients with 0, 1, 2, and 3 points were 11% (6 of 50), 14% (7 of 50), 42% (8 of 19), and 60% (3 of 5), respectively. In external validation datasets including patients already treated, 23 of 106 patients were diagnosed PA. AUC of PFK score was 0.73 (95% CI: 0.63-0.83), significantly higher than that of hypokalemia alone (0.53, 95% CI: 0.44-0.63, P &lt;0.01). Conclusion: We successfully developed the easy-to-use diagnostic score for predicting possible PA, PFK score which is superior to hypokalemia alone.

Prevalence and clinical characteristics of primary aldosteronism in Japanese patients with type 2 diabetes mellitus and hypertension

The prevalence of primary aldosteronism (PA) is around 3-15% in patients with hypertension. Hypertension is a frequent complication of type 2 diabetes mellitus (DM) because of the close etiological relationship between these two diseases. However, the possibility of PA in patients with DM and hypertension is often overlooked and the prevalence of PA in patients with DM and hypertension in Japan is unknown. We enrolled 124 hospitalized patients with both DM and hypertension. PA was diagnosed according to the modified criteria for Japanese patients. We examined the prevalence of PA and compared clinical characteristics between patients with and without PA. In another analysis of 43 patients with a confirmed diagnosis of PA, we compared the characteristics of patients with and without DM. Overall, 14/124 patients with DM and hypertension (11.3%) were diagnosed with PA. Multivariate logistic regression showed that the duration of DM was significantly shorter in the PA group. Fisher's direct probability test revealed that history of hypertension before the diagnosis of DM was a significant factor in patients with PA. Treatment with an angiotensin II receptor blocker (ARB) did not affect the diagnosis of PA in these patients. Among 43 patients with PA, those with DM were significantly older and the delay to the diagnosis of PA was significantly longer compared with patients without DM. In conclusion, almost 10% of patients with DM and hypertension actually have PA. More extensive screening for PA is recommended in patients with DM and hypertension, regardless of the use of ARBs.

PREVALENCE OF PRIMARY ALDOSTERONISM IN RESISTANT HYPERTENSION AND ITS ASSOCIATION WITH EARLY VASCULAR DAMAGE: PP.18.197

Introduction: The prevalence of primary aldosteronism (PAL) is 5–10% of hypertensive subjects and even higher than in subjects affected by resistant hypertension. Aldosterone seems to play an important role in the pathogenesis of the cardiovascular damage, but few controlled clinic trials have addressed this topic. Aim: To determine the prevalence of PAL in patients with resistant hypertension, admitted in our Hypertension Unit, and define the possible association with early cardiovascular damage. Methods: Data on the first 57 patients recruited. Cardiovascular risk and early cardiovascular damage indexes (microalbuminuria and intima-media thickness of common carotid arteries) were assessed being blind for the diagnosis of PAL (plasma aldosterone (pg/ml)/PRA (ng/ml/h) ratio >400 AND plasma aldosterone >200 basally AND >100 pg/ml after acute NaCl infusion) performed after adequate pharmacological wash-out). Results: PAL was diagnosed in 20 out of 57 subjects (35.1%, aged 55.1 ± 12.6), the remaining 37 were considered affected by essential hypertension (EI, 64.9%, aged 57.4 ± 9.5). Further diagnostic investigation (adrenal CT and selected sampling from adrenal veins) was considered in patients with PAL: histological diagnosis of aldosterone-producing adenoma was obtained in 4 out of 20 subjects with PAL. The two groups did not differ for BMI, smoking habit, glycemia, LDL cholesterol, HDL cholesterol and triglyceride levels, family history of hypertension, diabetes mellitus, premature CHD. Arterial pressure levels did not differ in the two groups (PAL vs. EI: SBP 175.0 ± 24.8 vs. 169.9 ± 23.7 mmHg; DBP 104.5 ± 10.9 vs. 98.0 ± 11.7 mmHg). 10 out of 20 patients with PAL (50%) and 2 out of 37 (5.4%) patients with EI showed hypokaliemia (<3.5 mEq/l). Potassium levels were significantly lower in PAL (3.5 ± 0.5 vs. 4.0 ± 0.5 mEq/l, p = 0.0005). In subjects with PAL, microalbuminuria (52.6% vs. 21%, p = 0.02) and intima-media thickness>0.9 mm (43.7% vs. 20.7%) was statistically more frequent, although the latter was not statistically significant (p = 0.09). Conclusions: Primary aldosteronism is very frequent in the hypertensive subjects resistant to the pharmacological therapy. Among these patients, those with primary aldosteronism show an earlier vascular damage.

Renin-angiotensin-aldosterone system in patients with sleep apnoea: prevalence of primary aldosteronism

Obstructive sleep apnoea (OSA) is a sleep disorder characterized by recurrent episodes of oxygen desaturation during sleep, representing an independent risk factor for cardiovascular disease, such as myocardial infarction, stroke, congestive heart failure and resistant hypertension. Several neurohormonal mechanisms have been suggested to account for blood pressure increases, such as sympathetic nervous system hyperactivity, oxidative stress, renin-angiotensin-aldosterone system (RAAS) activation, endothelin system activation, and endothelial dysfunction. The aim of this study was to evaluate the behaviour of RAAS and the presence of primary aldosteronism (PA) in these patients and possible correlations between RAAS and the severity of OSA. From October 2007 to November 2008 we studied 325 consecutive newly diagnosed hypertensive patients; 71 patients (21.8%) presented with clinical signs of sleep disorders, evaluated also through a specific questionnaire (Epworth Sleepiness Scale). In hypertensive patients with sleep disorders, 53 patients were affected by OSA; in this group 18 patients were affected by PA (five with aldosterone-producing adenoma (APA) and 13 with bilateral hyperplasia (IHA)); obesity was also demonstrated (BMI > 30 kg/m(2)). Overall, in patients with OSA PRA levels correlated positively with apnoea/hypopnoea index (AHI; r = 0.35; p<0.01), and in all groups the waist circumference and the neck circumference were correlated positively with AHI (r = 0.3 p<0.02 and r = 0.3 p<0.03, respectively). We revealed a high prevalence of PA in patients with OSA, and we can conclude that patients with hypertension and OSA, especially those who are newly diagnosed, must be evaluated for PA.

The Prevalence of Primary Aldosteronism in Diabetic Patients

Increased plasma aldosterone concentrations (PACs) are associated with higher cardiovascular risk and target organ damage (TOD). Hyperglycemia can potentiate the cellular effects of aldosterone, and the prevalence of diabetes in primary aldosteronism (PA) is 7%-59%. The prevalence of PA in hypertensive individuals is estimated to be 10%-14%. This study of 61 hypertensive diabetic patients not taking spironolactone and with serum creatinine values <2.5 mg/dL sought to establish the prevalence of PA in hypertensive diabetics and compare the prevalence of PA in patients with TOD with those patients without TOD. PA was suspected if PACs were >15 ng/dL and plasma renin activity was <1 ng/dL/h (ratio >30). Although 14 patients had suppressed renin with PACs >8 ng/dL (including two with PACs >11 ng/dL), none met our criteria for PA. There was no correlation between PAC and TOD. This study indicates that routine screening for PA in hypertensive diabetic patients is not justified and that PAC does not correlate with TOD. Further study is needed.