Hypokalemia in the Hypertensive Patient

Article1 June 1967Hypokalemia in the Hypertensive PatientWith Observations on the Incidence of Primary AldosteronismNORMAN M. KAPLAN, M.D., F.A.C.P.NORMAN M. KAPLAN, M.D., F.A.C.P.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-66-6-1079 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptHypokalemia has been used as the major diagnostic criterion for the diagnosis of primary aldosteronism. With this criterion, the prevalence of primary aldosteronism among the hypertensive population has been exceedingly small, with probably fewer than 1,000 cases having been recognized in the United States where the number of hypertensives has been estimated at 17 million (1).Conn (2) has recently proposed that primary aldosteronism is much more commonly found in normokalemic patients, suggesting that the prevalence may be 20% of the hypertensive population. He suggests that, in effect, the reliance upon hypokalemia has led to the recognition of only the...References1. GORDONDEVINE TB: Hypertension and Hypertensive Heart Disease in Adults. United States—1960-62. Vital and Health Statistics Data from the National Health Survey. National Center for Health Statistics, Series II, No. 13. U. S. Department of Health, Education, and Welfare. U. S. Government Printing Office, Washington, D. C., 1966. Google Scholar2. CONN JW: Plasma renin activity in primary aldosteronism. Importance in differential diagnosis and in research of essential hypertension. JAMA 190: 222, 1964. CrossrefMedlineGoogle Scholar3. CONNCOHENROVNERNESBIT JWELDRRM: Normokalemic primary aldosteronism. A detectable cause of curable "essential" hypertension. JAMA 193: 200, 1965. CrossrefMedlineGoogle Scholar4. KAPLAN NM: Primary aldosteronism with malignant hypertension. New Eng. J. Med. 269: 1282, 1963. CrossrefMedlineGoogle Scholar5. KLIMANPETERSON BRE: Double isotope derivative assay of aldosterone in biological extracts. J. Biol. Chem. 235: 1639, 1960. CrossrefMedlineGoogle Scholar6. KAPLAN NM: The steroid content of adrenal adenomas and measurements of aldosterone production in patients with essential hypertension and primary aldosteronism. J. Clin. Invest. In press, May 1967. CrossrefGoogle Scholar7. KAPLAN NM: Comparison of aldosterone secretion and excretion measurements (abstract). Clin. Res. 11: 221, 1963. Google Scholar8. LARAGHSEALEYSOMMERS JHJESC: Patterns of adrenal secretion and urinary excretion of aldosterone and plasma renin activity in normal and hypertensive subjects. Circ. Res. 18: 158, 1966. CrossrefGoogle Scholar9. CANNONAMESLARAGH PJRPJH: Relation between potassium balance and aldosterone secretion in normal subjects and in patients with hypertensive or renal tubular disease. J. Clin. Invest. 45: 865, 1966. CrossrefMedlineGoogle Scholar10. CONNCOHENROVNER JWELDR: Suppression of plasma renin activity in primary aldosteronism. JAMA 190: 213, 1964. CrossrefMedlineGoogle Scholar11. FOURMAN P: The ability of the normal kidney to conserve potassium. Lancet 1: 1042, 1952. CrossrefMedlineGoogle Scholar12. EVANSHUGHESMILNESTEINER BMNCMDS: Electrolyte excretion during experimental potassium depletion in man. Clin. Sci. 13: 305, 1954. MedlineGoogle Scholar13. WOMERSLEYDARRAGH RAJH: Potassium and sodium restriction in the normal human. J. Clin. Invest. 34: 456, 1955. CrossrefMedlineGoogle Scholar14. SQUIRESHUTH RDEJ: Experimental potassium depletion in normal human subjects. I. Relation of ionic intake to the renal conservation of potassium. J. Clin. Invest. 38: 1134, 1959. CrossrefMedlineGoogle Scholar15. BROOKSMCSWINEYPRUNTYWOOD RVRRFTFJ: Potassium deficiency of renal and adrenal origin. Amer. J. Med. 23: 391, 1957. CrossrefMedlineGoogle Scholar16. STANBURYGOWENLOCKMAHLER SWAHRF: Interrelationships of potassium deficiency and renal disease, in An International Symposium on Aldosterone, edited by MULLER, A., O'CONNOR, C. Little, Brown and Co., Boston, 1958, pp. 155-166. Google Scholar17. LIDDLEBLEDSOECOPPAGE GWTWS: A familial renal disorder simulating primary aldosteronism but with negligible aldosterone secretion. Trans. Ass. Amer. Physicians 76: 199, 1963. Google Scholar18. BAGSHAWECURTISGARNETT KDJRES: Effect of prolonged hydrocortisone administration on potassium metabolism. Lancet 1: 18, 1965. CrossrefMedlineGoogle Scholar19. CHRISTYLARAGH NPJH: Pathogenesis of hypokalemic alkalosis in Cushing's syndrome. New Eng. J. Med. 265: 1083, 1961. CrossrefMedlineGoogle Scholar20. ALLOTTSKELTON ENMO: Increased adrenocortical activity associated with malignant disease. Lancet 2: 278, 1960. CrossrefMedlineGoogle Scholar21. RELMANSCHWARTZ ASWB: The effect of DOCA on electrolyte balance in normal man and its relation to sodium chloride intake. Yale J. Biol. Med. 24: 540, 1952. MedlineGoogle Scholar22. AUGUSTNELSONTHORN JTDHGW: Response of normal subjects to large amounts of aldosterone. J. Clin. Invest. 37: 1549, 1958. CrossrefMedlineGoogle Scholar23. CONNKNOPFNESBIT JWRFRM: Clinical characteristics of primary aldosteronism from an analysis of 145 cases. Amer. J. Surg. 107: 159, 1964. CrossrefMedlineGoogle Scholar24. LARAGHULICKJANUSZEWICZKELLYLIEBERMAN JHSVWGS: Electrolyte metabolism and aldosterone secretion in benign and malignant hypertension. Ann. Intern. Med. 53: 259, 1960. LinkGoogle Scholar25. GOLDBERGMCCURDY MDK: Hyperaldosteronism and hypergranularity of the juxtaglomerular cells in renal hypertension. Metabolic studies. Ann. Intern. Med. 59: 24, 1963. LinkGoogle Scholar26. WRONG O: Incidence of hypokalaemia in severe hypertension. Brit. Med. J. 2: 419, 1961. CrossrefMedlineGoogle Scholar27. CRANEHARRIS MGJJ: Desoxycorticosterone secretion rates in hyperadrenocorticism. J. Clin. Endocr. 26: 1135, 1966. CrossrefGoogle Scholar28. BIGLIERI EG: Hypokalemic alkalosis and edema with increased desoxycorticosterone excretion. J. Clin. Endocr. 25: 884, 1965. CrossrefGoogle Scholar29. SCHWARTZSTECHELFISHMANFANKHAUSER GGHSIA: Clinical therapeutic evaluation of hydrochlorothiazide (Hydrodiuril). JAMA 170: 2057, 1959. CrossrefMedlineGoogle Scholar30. BARTELSEVANSTOWNLEY CCJARG: Chlorothiazide—a survey of its effects in hypertensive patients. Ibid., p. 1796. Google Scholar31. V. A. Cooperative Study on Antihypertensive Agents: III. Chlorothiazide alone and in combination with other agents: preliminary results. Arch. Intern. Med. (Chicago) 110: 230, 1962. CrossrefGoogle Scholar32. GRIEBLEJOHNSTONFULLER HGLCJB: Treatment of arterial hypertensive disease with diuretics. II. Effects on electrolytes and uric acid of bendroflumethiazide, potassium chloride, and spironolactone. Ibid., p. 34. Google Scholar33. EARLEYORLOFF LEJ: Thiazide diuretics. Ann. Rev. Med. 15: 149, 1964. CrossrefMedlineGoogle Scholar34. CONN JW: Personal communication. Google Scholar35. CORTESSHUMANCHANNICK FCRBJ: Primary aldosteronism, observations on 2 cases. Amer. J. Med. Sci. 239: 324, 1960. CrossrefMedlineGoogle Scholar36. SILENBIGLIERISLATONGALANTE WSEGPM: Management of primary aldosteronism: evaluation of potassium and sodium balance technic of adrenalectomy and operative results in 24 cases. Ann. Surg. 164: 600, 1966. CrossrefMedlineGoogle Scholar37. KUMARHALLNAKASHIMAGORNALL DAERAG: Studies on aldosterone. II. Hypertension as a cumulative effect of aldosterone administration. Canad. J. Biochem. 35: 113, 1957. MedlineGoogle Scholar38. HALLHALL CEO: Hypertension and hypersalimentation. I. Aldosterone hypertension. Lab. Invest. 14: 285, 1965. MedlineGoogle Scholar39. SELYESTONETIMIRASSCHAFFENBURG HHPSC: Influence of sodium chloride upon the actions of desoxycorticosterone acetate. Amer. Heart J. 37: 1009, 1949. CrossrefMedlineGoogle Scholar40. BARTTER FC: The mode of action of spirolactones and their use in the diagnosis of aldosteronism, in The Clinical Use of Aldosterone Antagonists, edited by BARTTER, F. C. Charles C Thomas, Publisher, Springfield, Ill., 1960, pp. 3-13. Google Scholar41. BROWNDAVIESLEVERPEARTROBERTSON JJDLAFWSJI: Plasma concentration of renin in a patient with Conn's syndrome with fibrinoid lesions of the renal arterioles: the effect of treatment with spironolactone. J. Endocr. 33: 279, 1965. CrossrefMedlineGoogle Scholar42. SCHRIBNERBURNELL BHJM: Interpretation of the serum potassium concentration. Metabolism 5: 468, 1956. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Dallas, TexasFrom the Department of Internal Medicine, The University of Texas Southwestern Medical School, Dallas, Tex.This study was supported by grant AM-06938-04, National Institute of Arthritis and Metabolic Diseases, and grant 5T01-GM 1421-01, National Institute of General Medical Sciences, National Institutes of Health, Bethesda, Md., and by the Dallas Heart Association, Dallas, Tex.This work was presented in part at the annual meeting of the American Society for Clinical Investigation, Endocrinology Section, Atlantic City, N. J., May 1, 1966.Requests for reprints should be addressed to Norman M. Kaplan, M.D., 5323 Harry Hines Blvd., Dallas, Tex. 75235. Nextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByPrimary Aldosteronism: a Continuum from Normotension to HypertensionPrevalence of Hypokalemia and Primary Aldosteronism in 5100 Patients Referred to a Tertiary Hypertension UnitThe prevalence of primary aldosteronism and evolving approaches for treatmentDiagnosis and treatment of primary aldosteronism: practical clinical perspectivesGenetics and pathophysiology of low-renin arterial hypertensionDiagnosis and Management of Primary AldosteronismPrimary Aldosteronism: From Genetic Causes to Clinical GuidelinesSecondary HypertensionPrevalence and Clinical Manifestations of Primary Aldosteronism Encountered in Primary Care PracticePrevelence of Primary Aldosteronism in an Urban Hypertensive PopulationThe Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice GuidelineA cross-sectional study of the effects of β-blocker therapy on the interpretation of the aldosterone/renin ratioPrimary Aldosteronism: A Field on the MoveEndocrine HypertensionPrimary AldosteronismPathophysiology, Diagnosis, and Treatment of Mineralocorticoid DisordersCombination of LC–MS/MS aldosterone and automated direct renin in screening for primary aldosteronismHyperaldosteronismPrimary aldosteronism: emerging trendsHyperaldosteronism as a Common Cause of Resistant HypertensionResistant Hypertension and Aldosterone: An UpdatePrimary HyperaldosteronismPrimary aldosteronismEndocrine HypertensionCommon Secondary Causes of Resistant Hypertension and Rational for TreatmentAldosteronism and Resistant HypertensionEndocrine Hypertension: Then and NowClinical Detection and Treatment of Adrenal DiseasePrimary HyperaldosteronismCase Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism: An Endocrine Society Clinical Practice GuidelinePrevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational studyA Tale of Two Patients With Mendelian HypertensionIs There an Unrecognized Epidemic of Primary Aldosteronism? (Pro)Primary aldosteronism: renaissance of a syndromePrimary aldosteronism: diagnostic and treatment strategiesAdrenal Cortex HypertensionAldosterone Excretion Among Subjects With Resistant Hypertension and Symptoms of Sleep ApneaAdrenal-Dependent HypertensionPrimary aldosteronism – treatment optionsMinireview: Primary Aldosteronism—Changing Concepts in Diagnosis and TreatmentPrimary aldosteronismScreening for primary aldosteronism7 Disorders of mineralocorticoid activitySURGICAL MANAGEMENT OF PRIMARY ALDOSTERONISM (CONN'S SYNDROME), A CORRECTABLE CAUSE OF HYPERTENSIONFurther evaluation of saline infusion for the diagnosis of primary aldosteronism.'Essential' hypertension with hypokalemiaUSE OF AN INTRAVENOUS SODIUM LOAD IN SCREENING FOR PRIMARY HYPERALDOSTERONISMPrimary Aldosteronism: Pathophysiology, Diagnosis and TreatmentDrug treatment of thyroid and adrenal disease during pregnancyEndocrine Aspects of Hypertension2 Primary hyperaldosteronismEndokrine Aspekte des HochdrucksPrimary hyperaldosteronismIdentification and differentiation of surgically correctable hypertension due to primary aldosteronismThe Interaction between the Gastrointestinal Tract and Nutrient IntakeClinical, biochemical and pathological features of low-renin ("primary") hyperaldosteronismPotassium MetabolismCase 17-1977Potassium HomeostasisOutpatient Screening Tests for Primary AldosteronismThe diagnosis and management of disorders of aldosterone productionPerspectives on the renin-angiotensin-aldosterone system in hypertensionDiastolic hypertension corrected by operation: A reviewStandards for quality care of hypertensive patients in office and hospital practiceReferencesAldosterone: Physiological and pathophysiological variations in manPreoperative Lateralisation of Aldosterone-Producing Tumours in Primary AldosteronismBRUCE A. SCOGGINS, Ph.D., CATHERINE J. ODDIE, M.Sc., WILLIAM S. C. HARE, M.D., JOHN P. COGHLAN, Ph.D.The generation and maintenance of metabolic alkalosisDynamic Changes in Plasma Aldosterone and Cortisol Levels and Renin Activity in Patients with Oligosymptomatic Adrenocortical Hypertension Simulating Essential HypertensionAldosterone, Deoxycorticosterone, and Corticosterone Metabolism in Benign Essential HypertensionMineralocorticoidsyndromeThe pattern of plasma renin activity and aldosterone secretion in normal and hypertensive subjects before and after saline infusionsThe pattern of electrolyte excretion in normal and hypertensive subjects before and after saline infusionsSystemic Arterial Hypertension in Pediatric PracticeHypermineralocorticoidismus und HypertonieREFERENCESHypertension, Adrenal Abnormalities, and Alterations in Plasma Renin ActivityJ. CAULlE GUNNELLS JR., M.D., F.A.C.P., W. L. MCGUFFIN JR., M.D., R. R. ROBINSON, M.D., F.A.C.P., C. E. GRIM, M.D., SAMUEL WELLS, M.D., DONALD SILVER, M.D., J. F. GLENN, M.D.Renal electrolyte cycles and mechanism of nocturia in primary aldosteronismOn the pathogenesis of metabolic alkalosis in hyperaldosteronismPlasmareninaktivit�t bei Hypertonien unter Stimulations- und SuppressionsbedingungenThe Control of Aldosterone Secretion and Its Relationship to the Diagnosis of HyperaldosteronismCase 17-1969Primary Aldosteronism: Diagnosis and TreatmentProgress in the Diagnosis of Secondary HypertensionA FIRST-ARCH SYNDROME VARIANT ?DIAGNOSING PRIMARY HYPERALDOSTERONISMIncidence of Suppressed Renin Activity and of Normokalemic Primary Aldosteronism in Hypertensive Negro PatientsSurgery of the Adrenal GlandRenin-Angiotensin-Aldosteronsystem bei Störungen der Blutdruckregulation 1 June 1967Volume 66, Issue 6Page: 1079-1090KeywordsArthritisEndocrinologyExcretionHeart diseasesHypertensionLongitudinal studiesMetabolic disordersPlasma renin activity Issue Published: 1 June 1967 CopyrightCopyright ©, 1967, by The American College of PhysiciansPDF DownloadLoading ...