title: Primary aldosteronism and hypertensive disease.
abstract: Recent studies in hypertensive populations that have used the serum aldosterone (SA) to plasma renin activity (PRA) ratio as a screening test have demonstrated a high prevalence of primary aldosteronism (PA). This frequency is higher than that previously described when hypokalemia was used as a screening tool. However, other factors, such as the characteristics of hypertensive disease, could also influence the prevalence of PA. We studied 609 essential hypertensive patients, classified according to the Joint National Committee VI (JNC VI), in 3 different stages depending on the severity of their hypertensive disease. We measured SA and PRA and calculated the SA-PRA ratio for all patients. An SA-PRA ratio >25 was detected in 63 of 609 patients, and the fludrocortisone test confirmed the PA diagnoses in 37 of 609 (6.1%) cases. PA prevalence according to hypertension stage was as follows: stage 1, 6 of 301 cases (1.99%); stage 2, 15 of 187 cases (8.02%); and stage 3, 16 of 121 cases (13.2%). PA patients were slightly younger than the other hypertensive patients (48.4+/-10.5 vs 53.6+/-10.2 years; P<0.05). Serum potassium levels were normal in 36 of 37 PA patients; only 1 patient had minor hypokalemia. Computed tomography scans showed bilateral adrenal enlargement in 7 and an adrenal nodule in 2 cases. In summary, we found a high frequency of PA in essential hypertensives classified in stages 2 and 3 according to the JNC VI. The low frequency of computed tomography scan abnormalities and hypokalemia suggests that the diagnosis for most PA patients corresponds to attenuated forms of the disease.
authors.affiliation: Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Lira 85, 5 piso, Santiago, Chile. cfardella@med.puc.cl
authors.forename: Lorena
authors.initials: L
authors.lastname: Mosso
authors.forename: Cristian
authors.initials: C
authors.lastname: Carvajal
authors.forename: Alexis
authors.initials: A
authors.lastname: González
authors.forename: Adolfo
authors.initials: A
authors.lastname: Barraza
authors.forename: Fernando
authors.initials: F
authors.lastname: Avila
authors.forename: Joaquín
authors.initials: J
authors.lastname: Montero
authors.forename: Alvaro
authors.initials: A
authors.lastname: Huete
authors.forename: Alessandra
authors.initials: A
authors.lastname: Gederlini
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Fardella
mesh_terms: D000450:Aldosterone / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D005438:Fludrocortisone; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis; D007008:Hypokalemia / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012083:Renin / Q000097:blood
chemical_list: D000450:Aldosterone; D012083:Renin; D005438:Fludrocortisone