Hyperaldosteronism among black and white subjects with resistant hypertension.
Recent reports suggesting that the prevalence of primary hyperaldosteronism may be higher than historically thought have relied on an elevated plasma aldosterone concentration/plasma renin activity ratio to either diagnose or identify subjects at high risk of having primary hyperaldosteronism and have not included suppression testing of all evaluated subjects. In this prospective study of 88 consecutive patients referred to a university clinic for resistant hypertension, we determined the 24-hour urinary aldosterone excretion during high dietary salt ingestion, baseline plasma renin activity, and plasma aldosterone in all subjects. Primary hyperaldosteronism was confirmed if plasma renin activity was <1.0 ng/mL per hour and urinary aldosterone was >12 microg/24-hour during high urinary sodium excretion (>200 mEq/24-hour). Eighteen subjects (20%) were confirmed to have primary hyperaldosteronism. The prevalence of hyperaldosteronism was similar in black and white subjects. Of the 14 subjects with confirmed hyperaldosteronism who have been treated with spironolactone, all have manifested a significant reduction in blood pressure. In this population, an elevated plasma aldosterone/plasma renin activity ratio (>20) had a sensitivity of 89% and a specificity of 71% with a corresponding positive predictive value of 44% and a negative predictive value of 96%. These data provide strong evidence that hyperaldosteronism is a common cause of resistant hypertension in black and white subjects. The accuracy of these results is strengthened by having done suppression testing of all evaluated subjects.
Calhoun
David A
DA
Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Ala, USA. dcalhoun@uab.edu
Nishizaka
Mari K
MK
Zaman
Mohammad A
MA
Thakkar
Roopal B
RB
Weissmann
Paula
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000407:Alabama / Q000453:epidemiology; D000450:Aldosterone / Q000097:blood / Q000652:urine; D044383:Black People; D001794:Blood Pressure / Q000187:drug effects; D004232:Diuretics / Q000627:therapeutic use; D004351:Drug Resistance; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology*; D006973:Hypertension / Q000188:drug therapy / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012083:Renin / Q000097:blood; D012680:Sensitivity and Specificity; D017673:Sodium Chloride, Dietary; D013148:Spironolactone / Q000627:therapeutic use; D044465:White People; D001741:Black or African American
D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D017673:Sodium Chloride, Dietary; D013148:Spironolactone; D000450:Aldosterone; D012083:Renin