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J Am Coll Cardiol, 2006; 48:2293-2300, doi:10.1016/j.jacc.2006.07.059 (Published online 9 November 2006).
© 2006 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: HYPERTENSION

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

Gian Paolo Rossi, MD, FACC, FAHA*, Giampaolo Bernini, MD, Chiara Caliumi, MD, Giovambattista Desideri, MD, Bruno Fabris, MD, Claudio Ferri, MD, Chiara Ganzaroli, MD, Gilberta Giacchetti, MD, Claudio Letizia, MD, Mauro Maccario, MD, Francesca Mallamaci, MD, Massimo Mannelli, MD, Mee-Jung Mattarello, MD, Angelica Moretti, MD, Gaetana Palumbo, MD, Gabriele Parenti, MD, Enzo Porteri, MD, Andrea Semplicini, MD, FAHA, Damiano Rizzoni, MD, Ermanno Rossi, MD, Marco Boscaro, MD, Achille Cesare Pessina, MD, PhD, Franco Mantero, MD PAPY Study Investigators

For a list of author affiliations, please see the Appendix

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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