December 12, 2023
View Full PaperLong-Term Follow-Up of Patients With Elevated Aldosterone-to-Renin Ratio but Negative Confirmatory Test: The Progression of Primary Aldosteronism Phenotypes
Key Result
Long-term follow-up of patients with an elevated aldosterone-to-renin ratio but negative confirmatory test revealed that 20% developed overt primary aldosteronism at a mean of 5 years.
Study Design
Type
Cohort (n=184)
Multicenter
Yes
Structured PICO
Does long-term follow-up identify newly diagnosed overt primary aldosteronism in hypertensive patients with an initially elevated aldosterone-to-renin ratio but negative confirmatory test?
P
Population
184 patients with arterial hypertension, a previously elevated aldosterone-to-renin ratio, and a negative confirmatory test for primary aldosteronism.
I
Intervention
Long-term clinical follow-up with repeated screening and confirmatory testing (seated saline infusion test or captopril challenge test) for primary aldosteronism.
O
Outcome
Incidence of newly diagnosed overt primary aldosteronism, defined by a positive confirmatory test.surrogate
Approximately 20% of hypertensive patients with an initially unconfirmed positive screening test for primary aldosteronism develop overt disease within 5 years, highlighting the need for longitudinal follow-up and repeat testing.
Abstract
BACKGROUND: About 10% of patients with arterial hypertension have a positive screening test for primary aldosteronism (PA) and 50% to 70% of them have a negative confirmatory test: the appropriate follow-up of these patients is currently unknown. We investigated the incidence of PA in patients with previous negative confirmatory testing, after at least a 2-year follow-up. METHODS: One hundred eighty-four patients with a previously elevated aldosterone-to-renin ratio followed by a negative confirmatory test were recruited in 2 hypertension centers (Torino and Munich). We repeated the screening test for PA and, if positive, the confirmatory test (seated saline infusion test or captopril challenge test). Primary end point of the study was the incidence of newly diagnosed overt PA, as defined by a positive confirmatory test. RESULTS: After a mean follow-up of 5 years, 20% of patients developed overt PA. When subtype diagnosis was offered systematically, one-third of patients displayed unilateral PA. Patients who developed PA showed worsening of blood pressure control and a higher rate of cardiac organ damage, despite similar implementation of antihypertensive therapy, compared with patients without PA. A mild progression of autonomous aldosterone secretion was evident even in patients without confirmed PA but with relatively stable control of blood pressure levels over time. CONCLUSIONS: About one-fifth of patients with a negative confirmatory test develop overt PA over time. A clinical follow-up of patients with a negative confirmatory test is advisable, along with the repetition of PA investigation, primarily in patients with worsening of blood pressure control.