title: Plasma aldosterone level within the normal range is less associated with cardiovascular and cerebrovascular risk in primary aldosteronism.
abstract: Previous studies showed higher risk of cardiovascular and cerebrovascular (CCV) events in primary aldosteronism compared with essential hypertension, but the patients of these studies were limited to primary aldosteronism patients with high plasma aldosterone concentration (PAC). The introduction of the aldosterone-renin ratio as the screening test for primary aldosteronism led to the recognition of primary aldosteronism patients with normal PAC (nPA). However, there is no information on the risk of primary aldosteronism including nPA.
  
  
  
  In this retrospectively and cross-sectional study, the clinical features and CCV event risk of primary aldosteronism at diagnosis including nPA were investigated and compared with essential hypertension. The study included 292 consecutive primary aldosteronism patients and 498 essential hypertension outpatients. All primary aldosteronism patients were diagnosed by autonomous aldosterone secretion using confirmatory tests, and then divided into nPA (n = 130) and primary aldosteronism patients with high PAC (hPA: n = 162) using a PAC cutoff level of less than 443 pmol/l (16 ng/dl), representing the normal upper limit of PAC.
  
  
  
  nPA patients were significantly older at diagnosis of primary aldosteronism and at onset of hypertension compared with hPA patients. They had milder hypokalemia and easier-to-control blood pressure. The results suggested that nPA could be considered a mild type of primary aldosteronism but not an early-stage hPA. Moreover, the risk of all CCV events in nPA was significantly lower than that in hPA (odds ratio 0.42, 95% confidence interval 0.18-0.90, P < 0.05) and not significantly higher than that in essential hypertension (odds ratio 0.95, 95% confidence interval 0.43-1.94, P = 0.899).
  
  
  
  This study suggests that aggressive diagnostic workout for nPA is less effective to prevent CCV events.
authors.affiliation: aDepartment of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Osaka bDepartment of Internal Medicine, Nishinomiya Municipal Central Hospital, Nishinomiya cDepartment of Internal Medicine, Kansai Rosai Hospital, Amagasaki, Hyogo dDepartment of Internal Medicine of Endocrinology and Metabolism, NTT West Osaka Hospital, Osaka eDepartment of Internal Medicine of Endocrinology and Metabolism, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano fSenrichuo Ekimae Clinic, Toyonaka gNakao Naika Clinic, Osaka hOffice of Biostatistics and Data Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Murata
authors.forename: Tetsuhiro
authors.initials: T
authors.lastname: Kitamura
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tamada
authors.forename: Kosuke
authors.initials: K
authors.lastname: Mukai
authors.forename: Shogo
authors.initials: S
authors.lastname: Kurebayashi
authors.forename: Tsunehiko
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Reiko D
authors.initials: RD
authors.lastname: Hayashi
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kouhara
authors.forename: Sachi
authors.initials: S
authors.lastname: Takeiri
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kajimoto
authors.forename: Makoto
authors.initials: M
authors.lastname: Nakao
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Hamasaki
authors.forename: Michio
authors.initials: M
authors.lastname: Otsuki
authors.forename: Iichiro
authors.initials: I
authors.lastname: Shimomura
mesh_terms: D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D000075222:Essential Hypertension; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood*; D006973:Hypertension / Q000503:physiopathology; D007008:Hypokalemia / Q000150:complications; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000450:Aldosterone; D012083:Renin