A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients.
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.
Rossi
Gian Paolo
GP
For a list of author affiliations, please see the.
Bernini
Giampaolo
G
Caliumi
Chiara
C
Desideri
Giovambattista
G
Fabris
Bruno
B
Ferri
Claudio
C
Ganzaroli
Chiara
C
Giacchetti
Gilberta
G
Letizia
Claudio
C
Maccario
Mauro
M
Mallamaci
Francesca
F
Mannelli
Massimo
M
Mattarello
Mee-Jung
MJ
Moretti
Angelica
A
Palumbo
Gaetana
G
Parenti
Gabriele
G
Porteri
Enzo
E
Semplicini
Andrea
A
Rizzoni
Damiano
D
Rossi
Ermanno
E
Boscaro
Marco
M
Pessina
Achille Cesare
AC
Mantero
Franco
F
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
D000450:Aldosterone