Key result
The pooled prevalence of primary aldosteronism in adults with acute stroke or transient ischemic attack was 5.8% (95% CI 1.6%-12.3%).
Why the study?
Patients with primary aldosteronism have a higher rate of cardiovascular events including stroke compared to blood pressure matched essential hypertension, prompting a summary of evidence on primary aldosteronism prevalence in acute stroke or TIA.
What is the prevalence of primary aldosteronism in patients with acute stroke or transient ischemic attack?
Meta-Analysis
Yes
What is the prevalence of primary aldosteronism in patients with acute stroke or transient ischemic attack?
A considerable proportion (5.8%) of patients with stroke or TIA have primary aldosteronism, suggesting a potential need for targeted screening in this population.
May support targeted PA screening in stroke/TIA; leaves open impact on outcomes and need for prospective trials.
Background and purpose: Primary aldosteronism (PA) is the most common endocrine cause of secondary hypertension with a prevalence of 14% in patients with newly diagnosed hypertension. Patients with PA experience a higher rate of cardiovascular events including stroke when compared to those with blood pressure matched essential hypertension. This systematic review and meta-analysis summarize current evidence on the prevalence of PA in patients with acute stroke or transient ischemic attack (TIA). Methods: Two reviewers independently reviewed the literature for observational studies on the prevalence of PA in patients with acute stroke or TIA. MEDLINE and Embase were searched for studies up to December 13, 2023. Results: Three single center studies conducted in Japan, Singapore and China were found to meet the inclusion criteria. The reported prevalence of PA in two cohort studies of adults with stroke or TIA were 3.1% and 4.0% and a third cross-sectional study in adults under 45 years old revealed a prevalence rate of 12.9%. Following a meta-analysis, the pooled prevalence of PA in adults with stroke or TIA is 5.8% [95% CI 1.6%-12.3%]. Conclusions: A considerable proportion of patients with stroke or TIA may have PA as the underlying cause of their hypertension. Given the increased risk of stroke associated with PA, clinicians should consider screening for PA in hypertensive patients with stroke or TIA. Further research is needed to evaluate the effect of timing and interfering medications on test results, which will inform an evidence-based approach to testing for PA following TIA or stroke. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022328644.
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McCarthy et al. (2024) conducted a meta-analysis in Acute stroke or transient ischemic attack. Primary aldosteronism was evaluated on Prevalence of primary aldosteronism (95% CI 1.6%-12.3%). The pooled prevalence of primary aldosteronism in adults with acute stroke or transient ischemic attack was 5.8% (95% CI 1.6%-12.3%).
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