title: A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients.
abstract: OBJECTIVE
  We prospectively investigated the prevalence of curable forms of primary aldosteronism (PA) in newly diagnosed hypertensive patients.
  
  
  BACKGROUND
  The prevalence of curable forms of PA is currently unknown, although retrospective data suggest that it is not as low as commonly perceived.
  
  
  METHODS
  Consecutive hypertensive patients referred to 14 hypertension centers underwent a diagnostic protocol composed of measurement of Na+ and K+ in serum and 24-h urine, sitting plasma renin activity, and aldosterone at baseline and after 50 mg captopril. The patients with an aldosterone/renin ratio >40 at baseline, and/or >30 after captopril, and/or a probability of PA (by a logistic discriminant function) > or =50% underwent imaging tests and adrenal vein sampling (AVS) or adrenocortical scintigraphy to identify the underlying adrenal pathology. An aldosterone-producing adenoma (APA) was diagnosed in patients who in addition to excess autonomous aldosterone secretion showed: 1) lateralized aldosterone secretion at AVS or adrenocortical scintigraphy, 2) adenoma at surgery and pathology, and 3) a blood pressure decrease after adrenalectomy. Evidence of excess autonomous aldosterone secretion without such criteria led to a diagnosis of idiopathic hyperaldosteronism (IHA).
  
  
  RESULTS
  A total of 1,180 patients (age 46 +/- 12 years) were enrolled; a conclusive diagnosis was attained in 1,125 (95.3%). Of these, 54 (4.8%) had an APA and 72 (6.4%) had an IHA. There were more APA (62.5%) and fewer IHA cases (37.5%) at centers where AVS was available (p = 0.002); the opposite occurred where AVS was unavailable.
  
  
  CONCLUSIONS
  In newly diagnosed hypertensive patients referred to hypertension centers, the prevalence of APA is high (4.8%). The availability of AVS is essential for an accurate identification of the adrenocortical pathologies underlying PA.
authors.affiliation: For a list of author affiliations, please see the.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Rossi
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bernini
authors.forename: Chiara
authors.initials: C
authors.lastname: Caliumi
authors.forename: Giovambattista
authors.initials: G
authors.lastname: Desideri
authors.forename: Bruno
authors.initials: B
authors.lastname: Fabris
authors.forename: Claudio
authors.initials: C
authors.lastname: Ferri
authors.forename: Chiara
authors.initials: C
authors.lastname: Ganzaroli
authors.forename: Gilberta
authors.initials: G
authors.lastname: Giacchetti
authors.forename: Claudio
authors.initials: C
authors.lastname: Letizia
authors.forename: Mauro
authors.initials: M
authors.lastname: Maccario
authors.forename: Francesca
authors.initials: F
authors.lastname: Mallamaci
authors.forename: Massimo
authors.initials: M
authors.lastname: Mannelli
authors.forename: Mee-Jung
authors.initials: MJ
authors.lastname: Mattarello
authors.forename: Angelica
authors.initials: A
authors.lastname: Moretti
authors.forename: Gaetana
authors.initials: G
authors.lastname: Palumbo
authors.forename: Gabriele
authors.initials: G
authors.lastname: Parenti
authors.forename: Enzo
authors.initials: E
authors.lastname: Porteri
authors.forename: Andrea
authors.initials: A
authors.lastname: Semplicini
authors.forename: Damiano
authors.initials: D
authors.lastname: Rizzoni
authors.forename: Ermanno
authors.initials: E
authors.lastname: Rossi
authors.forename: Marco
authors.initials: M
authors.lastname: Boscaro
authors.forename: Achille Cesare
authors.initials: AC
authors.lastname: Pessina
authors.forename: Franco
authors.initials: F
authors.lastname: Mantero
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000175:diagnosis; D000311:Adrenal Glands / Q000098:blood supply; D018246:Adrenocortical Adenoma / Q000150:complications / Q000175:diagnosis; D000328:Adult; D000450:Aldosterone / Q000097:blood; D001800:Blood Specimen Collection; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications* / Q000453:epidemiology* / Q000209:etiology; D006973:Hypertension / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011877:Radionuclide Imaging; D014680:Veins
chemical_list: D000450:Aldosterone