Arterial Hypertension, Atrial Fibrillation, and Hyperaldosteronism

Seccia, Teresa Maria; Caroccia, Brasilina; Adler, Gail K.; Maiolino, Giuseppe; Cesari, Maurizio; Rossi, Gian Paolo

doi:10.1161/hypertensionaha.116.08956

Cited by 64 publications

(39 citation statements)

References 74 publications

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“…Apart from structural effects, increased exposure to aldosterone also disturbs electric properties of myocardium via upregulation of calcium currents and induction of sarcoplasmic reticulum calcium overload. 57,58 In the general population, increased plasma aldosterone levels have been associated with hypertension, AF occurrence, obesity, concentric LV hypertrophy, and diastolic dysfunction. 59,60 Although aldosterone promotes myocardial remodeling, predisposing to AF, the development of AF further increases aldosterone levels.…”

Section: Aldosterone In Hypertension and Afmentioning

confidence: 99%

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Atrial Fibrillation and Hypertension

et al. 2017

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Section: Aldosterone In Hypertension and Afmentioning

confidence: 99%

“…59,60 Although aldosterone promotes myocardial remodeling, predisposing to AF, the development of AF further increases aldosterone levels. 58 Cardiac expression of mineralocorticoid receptors is increased in AF, and their density correlates with AF duration and aldosterone levels.…”

Section: Aldosterone In Hypertension and Afmentioning

confidence: 99%

Atrial Fibrillation and Hypertension

et al. 2017

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“…Data on confirmatory tests generally comes from studies with low levels of evidence due to small series of disease and control cases, the paucity of comparative studies simultaneously challenging different tests, the lack of one validated reference test for definitive PA diagnosis and therefore the tautological methodology consisting of arbitrarily choosing one test as the reference test, and the lack of consensus for positivity thresholds for confirmatory tests (25). Few studies have assessed the definitive diagnosis of an aldosterone-producing adenoma using a gold standard definition of APA (19,29,36,47) which includes the so-called 'four corners criteria' to which may be added a fifth criteria namely the detection of a CYP11B2-positive adenoma in the resected adrenal cortex at immunohistochemistry (8). All confirmatory tests presuppose that aldosterone secretion in PA is independent and dissociated from renin secretion, which in reality is far from always being the case (15,16,17,18,19).…”

Section: International Guideline Recommendations For the Use Of Confimentioning

confidence: 99%

“…A recent prospective study has confirmed a 5.9% prevalence of PA in 1672 unselected hypertensive patients from primary care centers (4). The diagnosis of PA is of paramount importance due to the increased associated morbidities, including altered renal function, atrial fibrillation, stroke, myocardial infarction and lastly cardiovascular mortality, in PA patients when compared to patients with essential hypertension (5,6,7,8). PA diagnosis should be raised in a number of conditions including: grade 2 and 3 hypertension, resistant hypertension, hypokalemia-associated hypertension, hypertension with obstructive sleep apnea, adrenal incidentaloma in hypertensive subjects, hypertension in subjects under 40 years of age and subjects with a family history of first-degree PA (3,9).…”

Section: Introductionmentioning

confidence: 96%

MANAGEMENT OF ENDOCRINE DISEASE: The role of confirmatory tests in the diagnosis of primary aldosteronism

Morera

Reznik

2019

European Journal of Endocrinology

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The strategy for diagnosis of primary aldosteronism (PA) in the hypertensive population includes firstly a screening step, based on the measurement of plasma aldosterone-to-renin ratio (ARR), a test which must have high sensitivity, and secondly a confirmatory step based on the demonstration of excessive aldosterone production independent of the renin-angiotensin-aldosterone system (RAAS) activity. The high proportion of false-positive ARR results and conversely of actual PA without a persistent elevation in baseline plasma aldosterone concentration necessitates the addition of a confirmatory step in the work-up of PA diagnosis. The present review focuses on the description of the different dynamic tests available for demonstrating autonomy of aldosterone secretion, on the performance and limitations of confirmatory tests and on possible strategies for PA diagnosis which may either include or avoid the confirmatory step for PA diagnosis. Large prospective studies comparing different strategies with and without dynamic testing are mandatory to delineate clearly the role and limits of confirmatory tests in the work-up of PA.

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“…About 10 years ago, the association of atrial fibrillation (AF) with hyperaldosteronism was recognized [19].…”

Section: Clinical and Laboratory Featuresmentioning

confidence: 99%

Update in diagnosis and management of primary aldosteronism

Dick

Queiroz

Bernardi

et al. 2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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Primary aldosteronism (PA) is a group of disorders in which aldosterone is excessively produced. These disorders can lead to hypertension, hypokalemia, hypervolemia and metabolic alkalosis. The prevalence of PA ranges from 5% to 12% around the globe, and the most common causes are adrenal adenoma and adrenal hyperplasia. The importance of PA recognition arises from the fact that it can have a remarkably adverse cardiovascular and renal impact, which can even result in death. The aldosterone-to-renin ratio (ARR) is the election test for screening PA, and one of the confirmatory tests, such as oral sodium loading (OSL) or saline infusion test (SIT), is in general necessary to confirm the diagnosis. The distinction between adrenal hyperplasia (AH) or aldosteroneproducing adenoma (APA) is essential to select the appropriate treatment. Therefore, in order to identify the subtype of PA, imaging exams such as computed tomography or magnetic ressonance imaging, and/or invasive investigation such as adrenal catheterization must be performed. According to the subtype of PA, optimal treatment -surgical for APA or pharmacological for AH, with drugs like spironolactone and amiloride -must be offered.

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Arterial Hypertension, Atrial Fibrillation, and Hyperaldosteronism

Cited by 64 publications

References 74 publications

Atrial Fibrillation and Hypertension

Atrial Fibrillation and Hypertension

MANAGEMENT OF ENDOCRINE DISEASE: The role of confirmatory tests in the diagnosis of primary aldosteronism

Update in diagnosis and management of primary aldosteronism

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