title: Screening for primary aldosteronism in hypertensive subjects: results from two German epidemiological studies.
abstract: OBJECTIVE
  The prevalence of primary aldosteronism in unselected hypertensive patients is currently unknown. We investigated the frequency of positive screening results for primary aldosteronism based on the aldosterone-to-renin ratio (ARR) in hypertensive subjects aged 30-79 years from two German epidemiological studies. We further examined the frequency of positive screening results in subjects with resistant hypertension or stage III hypertension and assessed possible disparities between untreated and treated hypertensive subjects.
  
  
  METHODS
  Data were obtained from the first follow-ups of the population-based study of health in Pomerania (SHIP; n=1392) and the cooperative health research in the region of Augsburg (KORA; n=1052). Study-specific reference ranges for plasma aldosterone concentration (PAC), plasma renin concentration (PRC) and the ARR were applied. Confirmation tests for primary aldosteronism were not performed in these epidemiological studies.Three definitions for a positive screening for primary aldosteronism were applied: A) increased ARR; B) increased ARR and decreased PRC; and C) increased ARR and increased PAC and decreased PRC.
  
  
  RESULTS
  The frequency of positive screening results was 7.0, 3.8 and 0.2% according to definitions A-C respectively. In the subgroups of subjects with resistant hypertension (11.9, 5.5 and 0.9%) or stage III hypertension (18.3, 14.0 and 1.1%), these frequencies were markedly higher than those in the general hypertensive population. There was no difference in the frequency of positive screening results between the treated and untreated hypertensive subjects.
  
  
  CONCLUSIONS
  A maximum of 7.0% of the hypertensive population in Germany shows a positive screening result for primary aldosteronism. Thus, primary aldosteronism may be less frequent than previously expected based on data from referred hypertensive patients.
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine, Ernst-Moritz-Arndt-University Greifswald, Ferdinand-Sauerbruch-Strasse, D-17475 Greifswald, Germany. anke.hannemann@uni-greifswald.de
authors.forename: A
authors.initials: A
authors.lastname: Hannemann
authors.forename: M
authors.initials: M
authors.lastname: Bidlingmaier
authors.forename: N
authors.initials: N
authors.lastname: Friedrich
authors.forename: J
authors.initials: J
authors.lastname: Manolopoulou
authors.forename: A
authors.initials: A
authors.lastname: Spyroglou
authors.forename: H
authors.initials: H
authors.lastname: Völzke
authors.forename: F
authors.initials: F
authors.lastname: Beuschlein
authors.forename: J
authors.initials: J
authors.lastname: Seissler
authors.forename: R
authors.initials: R
authors.lastname: Rettig
authors.forename: S B
authors.initials: SB
authors.lastname: Felix
authors.forename: R
authors.initials: R
authors.lastname: Biffar
authors.forename: A
authors.initials: A
authors.lastname: Döring
authors.forename: C
authors.initials: C
authors.lastname: Meisinger
authors.forename: A
authors.initials: A
authors.lastname: Peters
authors.forename: H E
authors.initials: HE
authors.lastname: Wichmann
authors.forename: M
authors.initials: M
authors.lastname: Nauck
authors.forename: H
authors.initials: H
authors.lastname: Wallaschofski
authors.forename: M
authors.initials: M
authors.lastname: Reincke
mesh_terms: D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D006973:Hypertension / Q000097:blood / Q000453:epidemiology*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D010808:Physical Examination; D015995:Prevalence; D012083:Renin / Q000097:blood
chemical_list: D000450:Aldosterone; D012083:Renin