Key result
Primary aldosteronism affects ~11% of newly diagnosed hypertensive patients referred to specialized centers.
Why the study?
The prevalence of curable forms of primary aldosteronism in newly diagnosed hypertensive patients was unknown despite retrospective data suggesting it is not low.
Observational (n=1,125)
Yes
Primary aldosteronism, particularly aldosterone-producing adenoma, has a high prevalence (4.8%) among newly diagnosed hypertensive patients referred to specialized centers, underscoring the importance of screening and the necessity of adrenal vein sampling for accurate diagnosis.
A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. ROSSI, GIANPAOLO ; BERNINI G; CALIUMI C; DESIDERI G; FABRIS B; FERRI C; GANZAROLI C; GIACCHETTI G; LETIZIA C; MACCARIO M; MALLAMACI F; MANNELLI M; MATTARELLO MJ; MORETTI A; PALUMBO G; PARENTI G; PORTERI E; SEMPLICINI, ANDREA ; RIZZONI D; ROSSI E; BOSCARO, MARCO ; PESSINA, ACHILLE CESARE ; MANTERO F. 2006 Abstract OBJECTIVES: We prospectively investigated the prevalence of curable forms of primary aldosteronism (PA) in newly diagnosed hypertensive patients. BACKGROUND: The prevalence of curable forms of PA is currently unknown, although retrospective data suggest that it is not as low as commonly perceived. METHODS: Consecutive hypertensive patients referred to 14 hypertension centers underwent a diagnostic protocol composed of measurement of Na+ and K+ in serum and 24-h urine, sitting plasma renin activity, and aldosterone at baseline and after 50 mg captopril. The patients with an aldosterone/renin ratio >40 at baseline, and/or >30 after captopril, and/or a probability of PA (by a logistic discriminant function) > or =50% underwent imaging tests and adrenal vein sampling (AVS) or adrenocortical scintigraphy to identify the underlying adrenal pathology. An aldosterone-producing adenoma (APA) was diagnosed in patients who in addition to excess autonomous aldosterone secretion showed: 1) lateralized aldosterone secretion at AVS or adrenocortical scintigraphy, 2) adenoma at surgery and pathology, and 3) a blood pressure decrease after adrenalectomy. Evidence of excess autonomous aldosterone secretion without such criteria led to a diagnosis of idiopathic hyperaldosteronism (IHA). RESULTS: A total of 1,180 patients (age 46 +/- 12 years) were enrolled; a conclusive diagnosis was attained in 1,125 (95.3%). Of these, 54 (4.8%) had an APA and 72 (6.4%) had an IHA. There were more APA (62.5%) and fewer IHA cases (37.5%) at centers where AVS was available (p = 0.002); the opposite occurred where AVS was unavailable. CONCLUSIONS: In newly diagnosed hypertensive patients referred to hypertension centers, the prevalence of APA is high (4.8%). The availability of AVS is essential for an accurate identification of the adrenocortical pathologies underlying PA.
No takes yet. Share an insight, caveat, or question.
Rossi et al. (2006) conducted an observational in Newly diagnosed hypertension (n=1,125). Primary aldosteronism vs. Primary (essential) hypertension was evaluated on Prevalence of aldosterone-producing adenoma (APA). In newly diagnosed hypertensive patients referred to specialized centers, the prevalence of primary aldosteronism was 11.2%, including a 4.8% prevalence of surgically curable aldosterone-producing adenomas.
Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context: