Prevalence Of Primary Aldosteronism 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 Complications in Type 2 Diabetes Mellitus Patients with Resistant Hypertension: A Prospective Observational Single Centre Study Protocol

Primary hyperaldosteronism (PA) has been thought to be an uncommon cause of hypertension, with an estimated prevalence of 2% among the general hypertensive population but is much higher, especially in resistant hypertension (RH) patients. Recent studies, however, have suggested that the prevalence of PA may be as high as 30% in RH populations. PA is associated with higher morbidity rates than matched essential hypertension patients. RH is more common in type 2 diabetes mellitus (T2DM). PA is generally remediable by treatment with an aldosterone antagonist or, in the case of adrenal adenoma, by adrenalectomy, knowing the true prevalence of PA is important for early diagnosis and treatment. Aim: This study aims to evaluate the prevalence of PA and cardiovascular (CVD) and renal complications in T2DM mellitus patients with resistant hypertension . Method: Prospective observational single centre study, in outpatient (OPD) settings in a tertiary care hospital. The primary outcome of the study is to estimate the prevalence of primary aldosteronism in T2DM patients with resistant hypertension. The secondary outcome is to evaluate the difference in prevalence of complications / comorbidities like CVD, left ventricle hypertrophy(LVH) , atrial fibrillation (AF), chronic kidney disease (CKD) in T2DM patients with and without PA hyperaldosteronism . T2DM patients aged more than 18 years with RH will be included in the study. Patients with type 1 diabetes mellitus or secondary causes of diabetes mellitus, acute diabetic complications, severe underlying systemic diseases, chronic kidney disease stage ≥4 , known secondary causes of hypertension, pregnancy and lactation and on medications like oral contraceptives, spironolactone, eplerenone, amiloride, triamterene will be excluded. Study subjects with plasma aldosterone to renin ratio of value ≥ 1.6 ng/dl/μIU/ml and plasma aldosterone concentration (PAC) of value ≥ 10 ng/dl with suppressed renin, will be considered to be positive on a screening test. Patients, those positive on a screening test will undergo seated saline suppression test (SST). Repeat plasma aldosterone concentration (PAC) with value ≥ 6 ng/dl will be confirmatory test for PA. Conclusion: RH specially in T2DM high-risk phenotype, which may be further aggravated by underlying PA . Thus we want to estimate the prevalence of PA in T2DM patients with RH. We also want to highlight any difference in prevalence of CV and renal complications due to in T2DM patients with and without PA, which may support early screening and diagnosis of PA and targeted treatment of PA to prevent its aggravating effects on chronic diabetes complications.

Aldosterone and renin concentrations and blood pressure in young Indigenous and non-Indigenous adults in the Northern Territory: a cross-sectional study.

To evaluate aldosterone and renin levels and aldosterone-to-renin ratios (ARRs) in young Indigenous and non-Indigenous adults in the Northern Territory, and their association with blood pressure levels. Cross-sectional study; single time point sub-study of two prospective birth cohort studies. Participants in the Aboriginal Birth Cohort (ABC) - born to Indigenous mothers at the Royal Darwin Hospital during 1987-1990 - and the Top End Cohort (TEC) - people born to non-Indigenous mothers in Darwin, recruited during 2007-2009 - aged 32-35 years at the time of this sub-study. Plasma aldosterone and direct renin concentrations; ARRs (positive screening test result for primary aldosteronism defined as > 70 pmol/mU); systolic and diastolic blood pressure. A total of 255 ABC (205 in remote, 50 in urban locations) and 76 TEC members participated. Median aldosterone concentration was similar for all three groups. The median renin concentration was 7.5 mU/L (interquartile range [IQR], 4.1-12.4 mU/L) in the TEC group, 12.4 mU/L (IQR, 5.1-19 mU/L) in the urban ABC group, and 29.3 mU/L (IQR, 15.0-52.9 mU/L) in the remote ABC group. The median ARR was 10 pmol/mU (IQR, 6-19 pmol/mU) in the remote ABC group, 28 pmol/mU (IQR, 16-70 pmol/mU) in the urban ABC group, and 43 pmol/mU (IQR, 26-74 pmol/mU) in the TEC group. Thirteen urban ABC participants (26%), 21 TEC participants (28%), and six people in the remote ABC group (3%) had ARR values above 70 pmol/mU. Adjusted for age and body mass index (BMI), mean systolic and diastolic blood pressure were lower for women than men in all participant groups; after adjusting for age, sex, and BMI, larger ARR was associated with higher systolic blood pressure in the TEC group but not the two ABC groups. Screening test results for primary aldosteronism were positive for about one-quarter of urban Indigenous and non-Indigenous participants. A prospective study that includes confirmatory testing would more accurately assess the prevalence of primary aldosteronism among Indigenous Australians in the Northern Territory.

A SYSTEMATIC REVIEW AND META-ANALYSIS ABOUT THE PREVALENCE OF FUNCTIONING ADRENAL INCIDENTALOMAS

Objective: Adrenal hyperfunction is associated with an increased risk of cardio-metabolic complications in subjects with adrenal incidentaloma. The aim of our study was to assess the prevalence of autonomous/possible autonomous cortisol secretion, primary aldosteronism, pheochromocytoma and Cushing syndrome in patients with adrenal incidentaloma. Design and method: We performed a comprehensive search of multiple databases (PubMed, Ovid MEDLINE, Web of Science) for potentially relevant studies without language restriction, up to February 2022. Studies were excluded if the diagnostic criteria used for diagnosing the hormonal alteration were not available or not in agreement with the available guidelines; in case of duplicate reports or if the studies were performed on selected cohorts of patients/specific populations. Results: We included 36 studies in the final analysis. The overall prevalence of functioning adrenal incidentalomas was 27.5%. Autonomous cortisol secretion/possible autonomous cortisol secretion, with a prevalence of 11.7% (95% C.I. 8.6, 15.7), was the most frequent hormonal alteration, while primary aldosteronism occurred in 4.4% of the patients (95% C.I. 3.1, 6.2). Subgroup analysis showed that primary aldosteronism was more prevalent in patients from Asia compared with patients from Europe/America, on the contrary, autonomous cortisol secretion/possible autonomous cortisol secretion had a lower prevalence in Asian countries. At meta-regression analysis, the prevalence of autonomous cortisol secretion/possible autonomous cortisol secretion was influenced by the proportion of female patients, while the prevalence of primary aldosteronism was positively associated with the proportion of patients with hypertension and the publication year. Finally, pheochromocytoma and Cushing syndrome prevalence were 3.8% (95% C.I. 2.8, 5.0) and 3.1% (95% C.I. 2.3, 4.3), respectively. Conclusions: We confirmed a wide heterogeneity among studies, that was partially explained by the differences in the populations included, such as the female gender and the geographical regions where patients were recruited; moreover, the year of the study publication plays a potential role in the observed effect, thus underlying an increasing awareness of these hormonal alterations in the latest years.

The Prevalence of Primary Aldosteronism in Screening Populations: Is Hypokalaemia Important?

The Prevalence of Primary Aldosteronism in Screening Populations: Is Hypokalaemia Important?

Prevalence of primary aldosteronism in patients with concomitant hypertension and obstructive sleep apnea, baseline data of a cohort.

Obstructive sleep apnea (OSA) and primary aldosteronism (PA) often coexist in hypertension, whereas whether hypertensive patients with OSA should be screened for PA is controversial and whether gender, age, obesity and OSA severity should be considered is unexplored. We explored cross-sectionally prevalence and associated factors of PA in co-existent hypertension and OSA by considering gender, age, obesity and OSA severity. OSA was defined as AHI ≥5 events/h. PA diagnosis was defined, based on the 2016 Endocrine Society Guideline. We included 3306 patients with hypertension (2564 with OSA). PA prevalence was significantly higher in hypertensives with OSA than in those without OSA (13.2 vs 10.0%, P = 0.018). In gender-specific analysis, PA prevalence was significantly higher in hypertensive men with OSA, compared to non-OSA ones (13.8 vs 7.7%, P = 0.001). In further analysis, PA prevalence was significantly higher in hypertensive men with OSA aged <45 years (12.7 vs 7.0%), 45-59 years (16.6 vs 8.5%), and with overweight and obesity (14.1 vs 7.1%) than did their counterparts (P < 0.05). For OSA severity, men participants showed increased PA prevalence from non to moderate OSA and a decrease in the severe OSA group (7.7 vs 12.9 vs 15.1 vs 13.7%, P = 0.008). Young and middle age, moderate-severe OSA, weight, and blood pressure showed a positive independent association with PA presence in logistic regression. In conclusion, PA is prevalent in co-existent hypertension and OSA, indicating the need for PA screening. Studies are needed for women, older and lean population due to the smaller samples in this study.

PS-R02-1: THE HIDDEN HAND BEHIND AN AORTIC DISSECTION CASE

According to the data of WHO, more than 1.1 billion people worldwide suffer from hypertension, which leads to complications such as aortic dissection, acute myocardial infarction, and heart failure seriously threaten human health. Previously, we believed that primary hypertension accounted for 80%-90% of all hypertension, but with the gradual increase in understanding and improvement of detection methods, the understanding of secondary hypertension factors is becoming clearer. Among the secondary hypertension, primary aldosteronism is receiving more and more attention. It is thought that the actual prevalence of primary aldosteronism may account for 30%-50% of hypertension. The dangers of primary aldosteronism are not only in the damage to target organs from blood pressure, but the damage to organs from elevated aldosterone appears much earlier. Early recognition of primary aldosteronism is important to reduce the emergence of complications. We report a case of a patient with aortic dissection with a previous history of thirty years of hypertension, regular medication and stable blood pressure control, who, after a sudden aortic dissection, had laboratory tests suggesting intractable hypokalemia and poor results with potassium supplementation. We further examined aldosterone and renin levels and found that renin levels were significantly lower, with an aldosterone/renin ratio of 72 (reference value: 0–38). Although the patient was not able to standardize medications at the time of examination due to his condition, the ARB, CCB and hydrochlorothiazide medications the patient was on were all elevated for renin. In this case, renin levels remained low and we have reason to believe that the patient could be diagnosed with primary aldosteronism. With this history, we recognize that screening for secondary hypertension is far from adequate, and some scholars believe that less than 1% of hypertensive patients worldwide are currently screened for secondary factors. We believe that screening for secondary hypertensive factors should be performed in all patients with aortic dissection, even whenever there is combined target organ damage in hypertensive patients, regardless of blood pressure values.

ПЕРВИЧНЫЙ АЛЬДОСТЕРОНИЗМ: СОВРЕМЕННЫЕ ПОДХОДЫ К ДИАГНОСТИКЕ

Primary aldosteronism is characterized by aldosterone secretion that is independent of renin and angiotensin II. The deleterious effects of primary aldosteronism are mediated by excessive activation of the mineralocorticoid receptor that results in the hypertension, hypokalemia, and it also increases the risk for cardiovascular and kidney disease, as well as death. Current evidence suggests that the prevalence of primary aldosteronism is much greater than previously recognized and milder forms of renin-independent aldosterone secretion may be common. These forms may be missed. This review focused screening in those at increased risk of primary aldosteronism. An approach to evaluating screening results was presented. Family aldosteronism should be considered in young hypertensive patients with a family history of primary aldosteronism. Genetic testing is appropriate in these patients. Careful interpretation of screening data, recent achievements in hormone assays and sampling methods and their clinical relevance are discussed. Confirmatory tests and evaluation of their results are considered. The optimal approach to distinguish unilateral from bilateral primary aldosteronism is by adrenal vein sampling that is the only reliable method to select patients for surgery. More effective strategy to diagnose PA should lead to early detection of PA and could decrease the cardiovascular complications of the patients.

ПЕРВИЧНЫЙ АЛЬДОСТЕРОНИЗМ: СОВРЕМЕННЫЕ ПОДХОДЫ К ДИАГНОСТИКЕ

Primary aldosteronism is characterized by aldosterone secretion that is independent of renin and angiotensin II. The deleterious effects of primary aldosteronism are mediated by excessive activation of the mineralocorticoid receptor that results in the hypertension, hypokalemia, and it also increases the risk for cardiovascular and kidney disease, as well as death. Current evidence suggests that the prevalence of primary aldosteronism is much greater than previously recognized and milder forms of renin-independent aldosterone secretion may be common. These forms may be missed. This review focused screening in those at increased risk of primary aldosteronism. An approach to evaluating screening results was presented. Family aldosteronism should be considered in young hypertensive patients with a family history of primary aldosteronism. Genetic testing is appropriate in these patients. Careful interpretation of screening data, recent achievements in hormone assays and sampling methods and their clinical relevance are discussed. Confirmatory tests and evaluation of their results are considered. The optimal approach to distinguish unilateral from bilateral primary aldosteronism is by adrenal vein sampling that is the only reliable method to select patients for surgery. More effective strategy to diagnose PA should lead to early detection of PA and could decrease the cardiovascular complications of the patients.

Prevalence of Primary Aldosteronism in Newly Diagnosed Hypertensive Patients in Primary Care.

Primary aldosteronism (PA) represents the most frequent cause of endocrine arterial hypertension. PA is also common in patients with mild forms of hypertension and normokalemia. To identify the prevalence of PA in newly diagnosed hypertensive patients in primary care in Southern Germany. Newly diagnosed hypertensive patients in 27 primary care centers in Munich agreed to participate in the study. Patients were screened for PA using the aldosterone-to-renin ratio (ARR). In case of elevated ARR, confirmation testing was performed. After the diagnosis of PA, subtype differentiation and subsequent therapy of PA were initiated. A total of 235 patients with newly discovered arterial hypertension were initially screened for PA. Among these, 35 were excluded because the medication indicated pre-existing treated arterial hypertension or they were on interfering antihypertensive medication. At the first screening, 2.0% of the patients had hypokalemia. Of the 200 patients with newly discovered arterial hypertension, 42 had an elevated ARR. The incidence of the presence of hypokalemia did not differ according to normal or pathological ARR. Nine patients (21%) did not show up for further testing and were lost to follow-up, and 33 patients underwent a saline infusion test. Of these, 11 patients were diagnosed with PA, leading to at least 5.5% prevalence of PA in the collective. None of the diagnosed PA patients was hypokalemic at screening. A 5.5% prevalence of PA was observed in our data of untreated newly diagnosed patients with hypertension.

Implementation of a formal sleep center–based screening protocol for primary aldosteronism in patients with obstructive sleep apnea

BackgroundThere is a bidirectional association between primary aldosteronism and obstructive sleep apnea, with evidence suggesting that the treatment of primary aldosteronism can reduce obstructive sleep apnea severity. Current guidelines recommend screening for primary aldosteronism in patients with comorbid hypertension and obstructive sleep apnea, identifying potential candidates for treatment. However, emerging data suggest current screening practices are unsatisfactory. Moreover, data regarding the true incidence of primary aldosteronism among this population are limited. This study aimed to assess the primary aldosteronism screening rate among patients with obstructive sleep apnea and hypertension at our institution and estimate the prevalence of primary aldosteronism among this population. MethodsSleep studies conducted at our institution between January and September 2021 were retrospectively reviewed. Adult patients with a sleep study diagnostic of obstructive sleep apnea (respiratory disturbance index ≥5) and a diagnosis of hypertension were included. Patient medical records were reviewed and laboratory data of those with biochemical screening for primary aldosteronism were assessed by an experienced endocrinologist. Screening rates were compared before and after initiation of a screening protocol in accordance with the 2016 Endocrine Society guidelines. ResultsA total of 1,005 patients undergoing sleep studies were reviewed; 354 patients had comorbid obstructive sleep apnea and hypertension. Patients were predominantly male (67%), with a mean age of 58 years (standard deviation = 12.9) and mean body mass index of 34 (standard deviation = 8.1). The screening rate for primary aldosteronism among included patients was 19% (n = 67). The screening rate was significantly higher after initiation of a dedicated primary aldosteronism screening protocol (23% vs 12% prior; P = .01). Fourteen screens (21%) were positive for primary aldosteronism, whereas 45 (67%) were negative and 8 (12%) were indeterminate. Four had prior abdominal cross-sectional imaging, with 3 revealing an adrenal adenoma. Compared with patients without primary aldosteronism, patients with positive primary aldosteronism screens were more likely to have a history of hypokalemia (36% vs 4.4%; P = .002). The frequency of hyperlipidemia, diabetes mellitus, and left ventricular hypertrophy did not differ between patients with positive versus negative screens. ConclusionCurrent screening practices for primary aldosteronism among patients with comorbid obstructive sleep apnea and hypertension are suboptimal. Patients evaluated at sleep centers may represent an optimal population for screening, as the prevalence of primary aldosteronism among this cohort appears high.

High Prevalence of Primary Aldosteronism in Patients with Type 2 Diabetes Mellitus and Hypertension.

Primary aldosteronism (PA) is the most common cause of endocrine hypertension. The prevalence of hypertension is higher in patients with diabetes mellitus-2 (DM-2). Following the limited existing data, we prospectively investigated the prevalence of aldosterone excess either as autonomous secretion (PA) or as a hyper-response to stress in hypertensive patients with DM-2 (HDM-2). A total of 137 HDM-2 patients and 61 non-diabetics with essential hypertension who served as controls (EH-C) underwent a combined, overnight diagnostic test, the Dexamethasone–captopril–valsartan test (DCVT) used for the diagnosis of PA and an ultralow dose (0.3 μg) ACTH stimulation test to identify an exaggerated aldosterone response to ACTH stimulation. Twenty-three normotensive individuals served as controls (NC) to define the normal response of aldosterone (ALD) and aldosterone-to-renin ratio (ARR) to the ultralow dose ACTH test. Using post-DCVTALD and ARR from the EH-C, and post-ACTH peak ALD and ARR from the NC, 47 (34.3%) HDM-2 patients were found to have PA, whereas 6 (10.4%) HDM-2 patients without PA (DCVT-negative) exhibited an exaggerated aldosterone response to stress—a prevalence much higher than ever reported. Treatment with mineralocorticoid receptor antagonists (MRAs) induced a significant and permanent reduction of BP in all HDM-2 patients. Early diagnosis and targeted treatment of PA is crucial to prevent any aggravating effect on chronic diabetic complications.

Who should be screened for primary aldosteronism? A comprehensive review of current evidence.

Arterial hypertension is a major risk factor for cardiovascular disease. The prevalence of primary aldosteronism (PA) ranges from 5% to 10% in the general hypertensive population and is regarded as one of the most common causes of secondary hypertension. There are two major causes of PA: bilateral adrenal hyperplasia and aldosterone‐producing adenoma. The diagnosis of PA comprises screening, confirmatory testing, and subtype differentiation. The Endocrine Society Practice Guidelines for the diagnosis and treatment of PA recommends screening of patients at an increased risk of PA. These categories include patients with stage 2 and 3 hypertension, drug‐resistant hypertension, hypertensive with spontaneous or diuretic‐induced hypokalemia, hypertension with adrenal incidentaloma, hypertensive with a family history of early onset hypertension or cerebrovascular accident at a young age, and all hypertensive first‐degree relatives of patients with PA. Recently, several studies have linked PA with obstructive sleep apnea and atrial fibrillation unexplained by structural heart defects and/or other conditions known to cause the arrhythmia, which may be partly responsible for the higher rates of cardiovascular and cerebrovascular accidents in patients with PA. The aim of this review is to discuss which patients should be screened for PA, focusing not only on well‐established guidelines but also on additional groups of patients with a potentially higher prevalence of PA, as has been reported in recent research.

Online prediction model for primary aldosteronism in patients with hypertension in Chinese population: A two-center retrospective study.

BackgroundThe prevalence of primary aldosteronism (PA) varies from 5% to 20% in patients with hypertension but is largely underdiagnosed. Expanding screening for PA to all patients with hypertension to improve diagnostic efficiency is needed. A novel and portable prediction tool that can expand screening for PA is highly desirable.MethodsClinical characteristics and laboratory data of 1,314 patients with hypertension were collected for modeling and randomly divided into a training cohort (919 of 1,314, 70%) and an internal validation cohort (395 of 1,314, 30%). Additionally, an external dataset (n = 285) was used for model validation. Machine learning algorithms were applied to develop a discriminant model. Sensitivity, specificity, and accuracy were used to evaluate the performance of the model.ResultsSeven independent risk factors for predicting PA were identified, including age, sex, hypokalemia, serum sodium, serum sodium-to-potassium ratio, anion gap, and alkaline urine. The prediction model showed sufficient predictive accuracy, with area under the curve (AUC) values of 0.839 (95% CI: 0.81–0.87), 0.814 (95% CI: 0.77–0.86), and 0.839 (95% CI: 0.79–0.89) in the training set, internal validation, and external validation set, respectively. The calibration curves exhibited good agreement between the predictive risk of the model and the actual risk. An online prediction model was developed to make the model more portable to use.ConclusionThe online prediction model we constructed using conventional clinical characteristics and laboratory tests is portable and reliable. This allowed it to be widely used not only in the hospital but also in community health service centers and may help to improve the diagnostic efficiency of PA.

Prevalence and clinical characteristics of primary aldosteronism in a tertiary-care center in Korea.

Approximately 29% of Korean adults have hypertension; however, the prevalence of primary aldosteronism among the hypertensive population is largely unknown. The aim of our study was to evaluate the prevalence and clinical characteristics of primary aldosteronism in a tertiary-care center in Korea. We retrospectively analyzed 1173 patients with newly diagnosed or preexisting hypertension who were referred to our tertiary-care hospital between January 2013 and December 2018. Patients were screened for primary aldosteronism with the aldosterone-renin ratio and underwent a saline infusion test for diagnostic confirmation. Adrenal computed tomography and adrenal venous sampling were performed for subtype classification for primary aldosteronism. Among the 1173 patients (mean age, 51.8 years; women, 53.2%), 360 (30.7%) had positive screening-test results, of whom 71 (6.1%) were finally diagnosed with primary aldosteronism. Conclusive subtype differentiation was made in 55 patients, of whom 15 (27%) had an aldosterone-producing adenoma, 4 (7%) had unilateral adrenal hyperplasia, and 36 (66%) had bilateral adrenal hyperplasia. Patients with primary aldosteronism had a higher ambulatory blood pressure, left ventricular mass index, and urinary albumin-to-creatinine ratio than those without. Moreover, the primary aldosteronism group had a higher prevalence of left ventricular hypertrophy and albuminuria than the non-primary aldosteronism group. Primary aldosteronism may be more common (6.1%) among Korean patients with hypertension than generally recognized. Primary aldosteronism was associated with a higher degree and prevalence of target organ damage and a higher blood pressure level. Wide application of screening tests for primary aldosteronism may be beneficial in detecting this potentially curable cause of hypertension.

PRIMARY ALDOSTERONISM: INITIAL EXPERIENCE FROM A NEWLY ESTABLISHED ESH HYPERTENSION CENTER OF EXCELLENCE - WORK IN PROGRESS

Objective: Primary aldosteronism is a common, yet underdiagnosed, cause of hypertension and resistant hypertension. It is estimated to be responsible for 6% of all cases of hypertension and 23% of all cases of resistant hypertension and is associated with disproportionately high rates of cardiovascular events and renal damage relative to the degree of hypertension. We sought to determine the prevalence of primary aldosteronism in patients referred to our center with the diagnosis of hypertension or resistant hypertension Design and method: From 08/03/2021 to 04/01/2022, 46 Patients (18 Females, 39.1%) were evaluated for primary aldosteronism. Thirty two patients (69.6%) were diagnosed with hypertension, of which 22 patients were newly diagnosed and were not on antihypertensive therapy. Fourteen patients (30.4%) were diagnosed with resistant hypertension and were on an average of 4 antihypertensive medications (range, 3 to 7). All were screened with Serum aldosterone (Ald) (pg/ml) and Plasma Renin activity (PRA) (mU/L) levels and ratio. To confirm the diagnosis, a seated saline suppression test (SSST) was performed when the Ald/PRA ratio was above 300. Adrenal computed tomography (CT) and adrenal vein sampling (AVS) were recommended or performed whenever the SSST was positive. Results: Of the 32 Patients with hypertension, 7 had an abnormal Ald/PRA ratio, 2 of which had a SSST which was positive in 1. Of the 14 patients with resistant hypertension, 7 (50%) had an abnormal Ald/PRA ratio, 4 of which underwent a SSST which was positive in all 4. Adrenal CT and AVS were done in 3 patients with resistant hypertension and positive SSST. AVS confirmed unilaterality in 2, both with adrenal adenomas. Adrenalectomy was recommended for the 2 patients and was performed in one with significant improvement in blood pressure control. Conclusions: Although this is a small number of evaluated patients, the data suggests that primary aldosteronism is not rare in hypertensive patients and is a common cause of resistant hypertension. All efforts should be made to improve physicians and patients’ awareness about its prevalence.

Autonomous Aldosterone Secretion as a Subclinical Form of Primary Aldosteronism: Pathogenesis and Clinical Significance.

In recent years, a substantial prevalence of primary aldosteronism (PA) has been demonstrated in both normotensive and mildly hypertensive cohorts. Consequently, a classic presentation of the syndrome, i. e. moderate-to-severe and resistant hypertension with concomitant hypokalemia, should be considered a tip-of-the-iceberg phenotype of a wide PA spectrum. Its entire range encompasses the non-classic clinical forms of mild hypertension and prehypertension but also several biochemical presentations, including patients who meet PA screening and confirmation test criteria, as well as those with either of them and those with other parameters indicating mineralocorticoid excess. In the current review, research insights on the pathogenetic background and clinical significance of autonomous aldosterone secretion (AAS) are presented, which is defined as a constellation of either: 1) normotension, normokalemia, a positive PA screening (high aldosterone-to-renin ratio) and/or confirmation test, or 2) hypertension, normokalemia and a positive PA screening but negative confirmation test. For this purpose, a literature search of the PubMed database was conducted. Advances in immunohistochemistry and genetic sequencing of isolated adrenal cells are provided as probable morphologic basis of the wide range of aldosterone secretion autonomy. Also, the role of corticotropin as an aldosterone secretagogue is discussed. To date, clinical studies depict consequences of subclinical PA phenotypes, such as increased mortality and risk of developing hypertension, impaired arterial and kidney function, association with metabolic syndrome and age, as well as osteoporosis.

Prevalence of primary aldosteronism in type 2 diabetes mellitus and hypertension: A prospective study from Western India.

Type 2 diabetes mellitus (T2DM) and hypertension commonly coexist; however,underlying primary aldosteronism (PA) can lead to worsening of hypertension, glycemia and cardiovascular risk. We aim to screen patients with T2DM and hypertension for PA by conducting a prospective monocentric study from Western India, which included adults with T2DM and hypertension from the outpatient diabetes clinic. Prospective study. Patients with an aldosterone renin ratio of ≥1.6 ng/dl/µIU/ml with plasma aldosterone concentration (PAC) ≥ 10 ng/dl were considered to be positive on a screening test. A PAC ≥ 6 ng/dl on seated saline suppression test (SST) was used to confirm the diagnosis of PA. Four hundred and eighty-six patients were included in thisstudy. Seventy-six (15.6%, 95% confidence interval [CI]: 12.7%-19.1%) patients had a positive screening test with positive confirmatory test in 20 of the 36 (55.5%, 95% CI: 39.3%-71.7%) screen-positive patients who underwent SST. Patients with positive screening test had a higher proportion of females (65.8% vs. 50%; p = .011), frequent history of hypertensive crises (21.1% vs. 8%; p = .001), uncontrolled blood pressure (51.3% vs. 34.6%; p = .006), diagnosis of hypertension before diabetes (32.9% vs. 21.7%; p = .035) and higher systolic (137.6 ± 6.9 vs. 131.2 ± 17.8 mmHg; p = .004) and diastolic (85.3 ± 11.1 vs. 81.7 ± 10.7 mmHg; p = .007) blood pressures. Patients with positive confirmatory test had longer duration of diabetes (108 [60-162] vs. 42 [24-87] months; p = .012), hypertension (84 [42-153] vs. 36 [15-81] months; p = .038) and higher creatinine (1.16 [1.02-1.42] vs. 0.95 [0.84-1.12] mg/dl; p = .021). PA is prevalent (at least 4.1%) in Asian Indian patients with T2DM and hypertension. Further studies are needed to assess the cost-effectiveness of routine screening.

Diagnosis and treatment of aldosterone-producing adenoma in a young patient: a clinical case

The prevalence of primary hyperaldosteronism (PHA) among individuals with essential arterial hypertension is about 5 to 10%. We present a clinical case of a 32 year old male patient, who despite the full clinical picture of PHA, was managed in primary care setting with the diagnosis of myalgia and treatment-resistant arterial hypertension. The article discusses clinical and laboratory parameters of the patient with the diagnosis of unilateral aldosteroma and the efficacy of its treatment. The generally accepted algorithm of PHA diagnosis with unilateral aldosterone-producing adenoma in young patients does not involve comparative selective blood sampling from adrenal veins. This accelerates the differential diagnosis and facilitates the decision to undertake surgery. This simplified diagnostic algorithm was successfully applied in the patient. Reasonable surgical intervention has led to the recovery of the patient. Awareness of various medical specialties of the up-to-date information on PHA and wide implementation of its screening into clinical practice, first of all, assessment of aldosterone-renin ratio, would allow for detection of the disease as early as possible and prevention of the development of life-threatening cardiovascular complications.

Renal denervation in hypertension patients: Proceedings from an expert consensus roundtable cosponsored by SCAI and NKF.

Renal denervation in hypertension patients: Proceedings from an expert consensus roundtable cosponsored by SCAI and NKF.