title: Primary aldosteronism among newly diagnosed and untreated hypertensive patients in a Swedish primary care area.
abstract: OBJECTIVE
  To evaluate the prevalence of primary aldosteronism (PA) in newly diagnosed and untreated hypertensive patients in primary care using the aldosterone/renin ratio (ARR), and to assess clinical and biochemical characteristics in patients with high and normal ARR.
  
  
  METHODS
  Patient survey study.
  
  
  METHODS
  A total of 200 consecutive patients with newly diagnosed and untreated hypertension from six primary health care centres in Sweden were included.
  
  
  METHODS
  ARR was calculated from serum aldosterone and plasma renin concentrations. The cut-off level for ARR was 65. Patients with an increased ARR were considered for confirmatory testing with the fludrocortisone suppression test (FST), followed by adrenal computed tomographic radiology (CT) and adrenal venous sampling (AVS).
  
  
  RESULTS
  Of 200 patients, 36 patients had an ARR > 65. Of these 36 patients, 11 patients had an incomplete aldosterone inhibition during FST. Three patients were diagnosed with an aldosterone producing adenoma (APA) and eight with bilateral adrenal hyperplasia (BHA). Except for moderately lower level of P-K in patients with an ARR > 65 and in patients with PA, there were no biochemical or clinical differences found among hypertensive patients with PA compared with patients without PA.
  
  
  CONCLUSIONS
  Eleven of 200 evaluated patients (5.5%) were considered to have PA. The diagnosis of PA should therefore be considered in newly diagnosed hypertensive subjects and screening for the diagnosis is warranted.
authors.affiliation: Department of General Practice, Lund University, Sweden. cwesterdahl@telia.com
authors.forename: Christina
authors.initials: C
authors.lastname: Westerdahl
authors.forename: Anders
authors.initials: A
authors.lastname: Bergenfelz
authors.forename: Anders
authors.initials: A
authors.lastname: Isaksson
authors.forename: Christina
authors.initials: C
authors.lastname: Nerbrand
authors.forename: Stig
authors.initials: S
authors.lastname: Valdemarsson
mesh_terms: D000311:Adrenal Glands / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D001800:Blood Specimen Collection; D005260:Female; D005438:Fludrocortisone; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood; D014057:Tomography, X-Ray Computed
chemical_list: D000450:Aldosterone; D012083:Renin; D005438:Fludrocortisone