Mineralocorticoid hypertension.
Hypertension with hypokalaemia and suppression of plasma renin activity is known as mineralocorticoid hypertension. Although mineralocorticoid hypertension accounts for a small number of patients labelled as having "essential" hypertension, it is a potentially reversible cause of high blood pressure. The most common cause of mineralocorticoid hypertension is probably primary aldosteronism; controlled posture studies to measure plasma renin activity and aldosterone concentrations, followed by adrenal imaging, will ensure the differential diagnosis between an aldosterone-producing adenoma and idiopathic adrenal hyperplasia in most cases. Three monogenic forms of mineralocorticoid hypertension have been described: glucocorticoid-suppressible hyperaldosteronism, Liddle's syndrome, and apparent mineralocorticoid excess, which have provided new insights into mineralocorticoid hormone action. Many patients with mineralocorticoid-based hypertension are now known to have normal serum potassium concentrations. Until the true prevalence of primary aldosteronism and monogenic forms of mineralocorticoid hypertension are defined, a high index of suspicion is needed in every hypertensive patient. Hypertensive patients with hypokalaemia, together with those with severe hypertension or a family history of hypertension or stroke, should be screened for mineralocorticoid excess.
Stewart
P M
PM
Department of Medicine, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK. p.m.stewart@bham.ac.uk
D000465:Algorithms; D006801:Humans; D006929:Hyperaldosteronism / Q000453:epidemiology / Q000235:genetics*; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D007008:Hypokalemia / Q000235:genetics; D008901:Mineralocorticoids / Q000378:metabolism; D015995:Prevalence
D008901:Mineralocorticoids