Prevalence of primary aldosteronism among unselected hypertensive patients: A prospective study based on the use of an aldosterone/renin ratio above 25 as a screening test

Roberto Fogari, Paola Preti, Annalisa Zoppi, Andrea Rinaldi, Elena Fogari, Amedeo Megullini

Research output: Contribution to journalArticle

Abstract

Primary aldosteronism (PA) has been considered a rare cause of hypertension. The introduction of the aldosterone/renin ratio (ARR) as a screening test has led to an increase in the detection rate. The aim of this study was to evaluate the prevalence of PA among unselected hypertensive patients by using an ARR >25 as a screening test. We studied 3,000 consecutive unselected hypertensive patients. Blood samples for the determination of plasma renin activity (PRA), aldosterone (ALD) and electrolytes were drawn in the morning, and patients with an ARR >25 underwent intravenous saline infusion as a confirmatory test. Adrenal CT and a dexamethasone suppression test were performed in patients with confirmed PA. Patients with a positive dexamethasone test underwent genetic testing for glucocorticoid-remediable aldosteronism (GRA). Out of 3,000 hypertensives, 684 (22.8%) showed an ARR >25 and 177 of them (5.9% of the whole population) had a positive saline loading test. Only 44 of them (24.8%) were hypokalemic. CT was performed in all the patients with confirmed PA and 53 of them (29.9%) had a solitary adrenal macroadenoma, 112 (63.3%) had bilateral adrenal enlargement and 12 (6.8%) had normal appearing adrenal glands. Of 177 patients given dexamethasone to identify GRA, 8 (4.5%) showed aldosterone suppression but only one (0.1%) tested positive for the chimeric gene. In conclusion, our findings indicate that standardized application of an ARR >25 to unselected hypertensive patients, followed by i.v. saline loading as a confirmatory test, can result in the detection of a large number of patients with PA (5.9% of the studied population), most of whom are normokalemic. Bilateral adrenal hypertrophy represents the more common form of PA.

Original languageEnglish
Pages (from-to)111-117
Number of pages7
JournalHypertension Research
Volume30
Issue number2
DOIs
Publication statusPublished - Feb 2007

Fingerprint

Hyperaldosteronism
Aldosterone
Renin
Prospective Studies
Dexamethasone
Genetic Testing
Adrenal Glands
Intravenous Infusions
Hypertrophy
Electrolytes
Population
Hypertension

Keywords

  • Epidemiology
  • Hypertension
  • Primary aldosteronism

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Prevalence of primary aldosteronism among unselected hypertensive patients : A prospective study based on the use of an aldosterone/renin ratio above 25 as a screening test. / Fogari, Roberto; Preti, Paola; Zoppi, Annalisa; Rinaldi, Andrea; Fogari, Elena; Megullini, Amedeo.

In: Hypertension Research, Vol. 30, No. 2, 02.2007, p. 111-117.

Research output: Contribution to journalArticle

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abstract = "Primary aldosteronism (PA) has been considered a rare cause of hypertension. The introduction of the aldosterone/renin ratio (ARR) as a screening test has led to an increase in the detection rate. The aim of this study was to evaluate the prevalence of PA among unselected hypertensive patients by using an ARR >25 as a screening test. We studied 3,000 consecutive unselected hypertensive patients. Blood samples for the determination of plasma renin activity (PRA), aldosterone (ALD) and electrolytes were drawn in the morning, and patients with an ARR >25 underwent intravenous saline infusion as a confirmatory test. Adrenal CT and a dexamethasone suppression test were performed in patients with confirmed PA. Patients with a positive dexamethasone test underwent genetic testing for glucocorticoid-remediable aldosteronism (GRA). Out of 3,000 hypertensives, 684 (22.8{\%}) showed an ARR >25 and 177 of them (5.9{\%} of the whole population) had a positive saline loading test. Only 44 of them (24.8{\%}) were hypokalemic. CT was performed in all the patients with confirmed PA and 53 of them (29.9{\%}) had a solitary adrenal macroadenoma, 112 (63.3{\%}) had bilateral adrenal enlargement and 12 (6.8{\%}) had normal appearing adrenal glands. Of 177 patients given dexamethasone to identify GRA, 8 (4.5{\%}) showed aldosterone suppression but only one (0.1{\%}) tested positive for the chimeric gene. In conclusion, our findings indicate that standardized application of an ARR >25 to unselected hypertensive patients, followed by i.v. saline loading as a confirmatory test, can result in the detection of a large number of patients with PA (5.9{\%} of the studied population), most of whom are normokalemic. Bilateral adrenal hypertrophy represents the more common form of PA.",
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