title: Evidence of primary aldosteronism in a predominantly female cohort of normotensive individuals: a very high odds ratio for progression into arterial hypertension.
abstract: BACKGROUND
  Primary aldosteronism (PA) is an established cause of hypertension, whereas high-normal serum aldosterone levels have been linked to an increased risk for hypertension.
  
  
  OBJECTIVE
  We aimed to define the post-fludrocortisone-dexamethasone suppression test (FDST) normal cutoff values of aldosterone and the aldosterone to renin ratio and evaluate the presence of PA in normotensive individuals.
  
  
  METHODS
  This study was designed as a case-control study.
  
  
  METHODS
  The study was performed in a tertiary general hospital.
  
  
  METHODS
  One hundred normotensive participants (80 females), mean age 53 years, were studied.
  
  
  METHODS
  All participants underwent baseline biochemical and hormonal evaluation, FDST, and adrenal computerized tomography. Blood pressure was assessed at baseline and after 5 years.
  
  
  RESULTS
  Sixty-nine participants with normal adrenal computerized tomography who remained normotensive after 5 years were used as a control population to calculate the cutoff values of adequate aldosterone suppression. PA was defined as a combination of post-FDST aldosterone to renin ratio of 0.93 ng/dL · μU/mL or greater (100% sensitivity and 96% specificity) and post-FDST aldosterone of 2.96 ng/dL or greater (100% sensitivity and 61% specificity on receiver-operating characteristic analysis). Thirteen of 100 participants had PA at baseline and 11 (85%) developed hypertension, whereas only 20 of 87 without PA (23%) developed hypertension at 5 years [odds ratio (OR) 18.42, 95% confidence intervals (CI) 3.76-90.10, P < .0001]. Logistic regression analysis showed a positive relation of PA [odds ratio (OR) 16.30, confidence interval (CI) 1.78-150.30, P = .01] and a negative relation of serum potassium (OR 0.39, CI 0.19-0.79, P = .01) with the development of hypertension.
  
  
  CONCLUSIONS
  Normotensive PA represents a clinical entity referring to normotensive individuals with PA who are at increased risk for hypertension.
authors.affiliation: Department of Endocrinology and Diabetes Center, Athens General Hospital G. Gennimatas, Athens, Greece.
authors.forename: Athina
authors.initials: A
authors.lastname: Markou
authors.forename: Theodora
authors.initials: T
authors.lastname: Pappa
authors.forename: Gregory
authors.initials: G
authors.lastname: Kaltsas
authors.forename: Aggeliki
authors.initials: A
authors.lastname: Gouli
authors.forename: Kostas
authors.initials: K
authors.lastname: Mitsakis
authors.forename: Panayiotis
authors.initials: P
authors.lastname: Tsounas
authors.forename: Anastasia
authors.initials: A
authors.lastname: Prevoli
authors.forename: Vaios
authors.initials: V
authors.lastname: Tsiavos
authors.forename: Labrini
authors.initials: L
authors.lastname: Papanastasiou
authors.forename: George
authors.initials: G
authors.lastname: Zografos
authors.forename: George P
authors.initials: GP
authors.lastname: Chrousos
authors.forename: George P
authors.initials: GP
authors.lastname: Piaditis
mesh_terms: D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D016022:Case-Control Studies; D015331:Cohort Studies; D003907:Dexamethasone; D003940:Diagnostic Techniques, Endocrine; D018450:Disease Progression; D005260:Female; D005438:Fludrocortisone; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology*; D006973:Hypertension / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012744:Sex Ratio
chemical_list: D000450:Aldosterone; D003907:Dexamethasone; D005438:Fludrocortisone