This article is more than 5 years old. Information may no longer be current.
Hypertension may not increase risk for primary aldosteronism
Click Here to Manage Email Alerts
People with hypertension may not be at increased risk for primary aldosteronism compared with people without hypertension; however, people with resistant hypertension should be screened for primary aldosteronism, recent study data suggest.
“In our particular population, we did not find the prevalence of disease that has been demonstrated in other studies,” Sandi Jo Galati, MD, clinical endocrinology at Endocrine and Diabetes Specialists of CT, PriMed Physicians, told Endocrine Today. “This suggests there are other underlying predisposing factors to disease presence which need to be elucidated. Several familial causes of primary aldosteronism have been described, but are rare. The disparity in disease prevalence between our population and the European population suggests there are other genetic and epigenetic factors at play.”
Sandi Jo Galati
Galati and colleagues evaluated data from 296 adults with hypertension, defined as two blood pressure measurements of more than 140/90 mm Hg or current treatment with antihypertensive medications, recruited from a primary care clinic at Mount Sinai Hospital between August 2012 and May 2013.
Elevated plasma aldosterone concentration and aldosterone:renin ratio suggestive of primary aldosteronism was present in 14 participants (cases), for an overall prevalence of 4.7% on initial testing. Six of these participants underwent an oral salt-load confirmatory test, and there were two confirmed positive cases of primary aldosteronsim for a prevalence of 0.7%.
Compared with participants screening negative for primary aldosteronism (controls), cases had significantly higher plasma aldosterone concentration levels (P < .001) and significantly lower plasma renin activity levels (P < .0463).
Compared with controls, cases were more likely to have resistant hypertension (P = .0334) and were more likely to require more anti-hypertensive agents (P = .0213).
“We know that the prevalence of primary aldosteronism has been demonstrated to be upwards of 10% in some study populations and also higher in hypertensive patients with certain other co-existing diseases such as diabetes and obstructive sleep apnea,” Galati told Endocrine Today. “Moving forward, we need to determine what populations are at highest risk for primary aldosteronism so that these patients can be screened early and effectively for this potentially curable disease.” – by Amber Cox
For more information:
Sandi Jo Galati, MD, can be reached at sandijo.galati@gmail.com.
Disclosure: Galati reports being a consultant for Corcept Therapeutics.
Perspective
Back to Top
John W. Funder
In a cohort of 296 patients presenting to the primary care clinic at the Mount Sinai Hospital, Galanti and colleagues found 14 to screen positive on the aldosterone/renin ratio (ARR); of these 14, only six agreed to undergo confirmatory testing, with two adjudged to have primary aldosteronsim. On this basis they claim a prevalence of 0.7% (2/296).
There are a number of reasons why this claim is open to major challenge, as follows:
- Average clinic systolic BP was 137 ± 23 mm Hg for the 14 ARR-positive patients and 136 ± 19 mm Hg for the remainder: diastolic BP values were 71.6 ± 12 mm Hg and 73.9 ± 12 mm Hg (presumably on treatment).Conclusion: some patients were not hypertensive; others prehypertensive; some hypertensive.
- The samples for plasma renin activity were sent to the laboratory on ice. Cryoactivation of prorenin raises measured renin levels above those in plasma. Conclusion: factitiously high measured plasma renin activity levels increase the denominator in the ARR, leading to factitiously low levels of elevated ARR and thus underestimate positives.
- Of the 14 ARR-positive patients, seven refused follow-up confirmatory/exclusion testing, and one — with the highest ARR — is listed as “expired.” The authors then report their findings as indicating a prevalence of 0.7%. They do not take into account the eight patients not confirmed/excluded. Conclusion: on the basis that two or three of the eight non-tested ARR-positive patients were confirmed (like two of six of those tested), the measured prevalence would be 4/296 or 5/296, ie, 1.3% or 1.7%.
Disclosure: Funder reports financial or business/organizational interests with the Department of Veterans Affairs, Garnett Passe and the Rodney Williams Memorial Foundation and serving as a consultant for Pfizer/Japan.
Click Here to Manage Email Alerts