Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents.
Primary aldosteronism (PA) is a common form of endocrine hypertension previously believed to account for less than 1% of hypertensive patients. Hypokalemia was considered a prerequisite for pursuing diagnostic tests for PA. Recent studies applying the plasma aldosterone/plasma renin activity ratio (ARR) as a screening test have reported a higher prevalence. This study is a retrospective evaluation of the diagnosis of PA from clinical centers in five continents before and after the widespread use of the ARR as a screening test. The application of this strategy to a greater number of hypertensives led to a 5- to 15-fold increase in the identification of patients affected by PA. Only a small proportion of patients (between 9 and 37%) were hypokalemic. The annual detection rate of aldosterone-producing adenoma (APA) increased in all centers (by 1.3-6.3 times) after the wide application of ARR. Aldosterone-producing adenomas constituted a much higher proportion of patients with PA in the four centers that employed adrenal venous sampling (28-50%) than in the center that did not (9%). In conclusion, the wide use of the ARR as a screening test in hypertensive patients led to a marked increase in the detection rate of PA.
Mulatero
Paolo
P
Hypertension Unit, Department of Medicine and Experimental Oncology, University of Torino, 10133 Turin, Italy. paolo.mulatero@libero.it
Stowasser
Michael
M
Loh
Keh-Chuan
KC
Fardella
Carlos E
CE
Gordon
Richard D
RD
Mosso
Lorena
L
Gomez-Sanchez
Celso E
CE
Veglio
Franco
F
Young
William F
WF
D000450:Aldosterone / Q000097:blood*; D002677:Chile; D005500:Follow-Up Studies; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery; D006973:Hypertension / Q000175:diagnosis; D007008:Hypokalemia / Q000175:diagnosis; D007558:Italy; D008403:Mass Screening; D008910:Minnesota; D011793:Queensland; D012083:Renin / Q000097:blood*; D012189:Retrospective Studies; D012846:Singapore
D000450:Aldosterone; D012083:Renin