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CLINICAL RESEARCH: HYPERTENSION

A Prospective Study of the Prevalence of Primary Aldosteronism in 1,125 Hypertensive Patients

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Manuscript received May 10, 2006; revised manuscript received July 13, 2006, accepted July 23, 2006.

^_* Reprint requests and correspondence: Prof. Gian Paolo Rossi, DMCS Clinica Medica 4, University Hospital, Via Giustiniani 2, 35126 Padova, Italy. (Email: gianpaolo.rossi{at}unipd.it).

OBJECTIVES: We prospectively investigated the prevalence of curable forms of primary aldosteronism (PA) in newly diagnosed hypertensive patients.

BACKGROUND: The prevalence of curable forms of PA is currently unknown, although retrospective data suggest that it is not as low as commonly perceived.

METHODS: Consecutive hypertensive patients referred to 14 hypertension centers underwent a diagnostic protocol composed of measurement of Na⁺ and K⁺ in serum and 24-h urine, sitting plasma renin activity, and aldosterone at baseline and after 50 mg captopril. The patients with an aldosterone/renin ratio >40 at baseline, and/or >30 after captopril, and/or a probability of PA (by a logistic discriminant function) 50% underwent imaging tests and adrenal vein sampling (AVS) or adrenocortical scintigraphy to identify the underlying adrenal pathology. An aldosterone-producing adenoma (APA) was diagnosed in patients who in addition to excess autonomous aldosterone secretion showed: 1) lateralized aldosterone secretion at AVS or adrenocortical scintigraphy, 2) adenoma at surgery and pathology, and 3) a blood pressure decrease after adrenalectomy. Evidence of excess autonomous aldosterone secretion without such criteria led to a diagnosis of idiopathic hyperaldosteronism (IHA).

RESULTS: A total of 1,180 patients (age 46 ± 12 years) were enrolled; a conclusive diagnosis was attained in 1,125 (95.3%). Of these, 54 (4.8%) had an APA and 72 (6.4%) had an IHA. There were more APA (62.5%) and fewer IHA cases (37.5%) at centers where AVS was available (p = 0.002); the opposite occurred where AVS was unavailable.

CONCLUSIONS: In newly diagnosed hypertensive patients referred to hypertension centers, the prevalence of APA is high (4.8%). The availability of AVS is essential for an accurate identification of the adrenocortical pathologies underlying PA.

Abbreviations and Acronyms   APA = aldosterone-producing adenoma   ARR = aldosterone/renin ratio   AVS = adrenal vein sampling   CT = computed tomography   HT = hypertension   IHA = idiopathic hyperaldosteronism   LDF = logistic discriminant analysis   MR = magnetic resonance   PA = primary aldosteronism   PRA = plasma renin activity

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