Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline

Funder, John W.; Carey, Robert M.; Fardella, Carlos E.; Gómez-Sánchez, Celso E.; Mantero, Franco; Stowasser, Michael; Young, William F.; Montori, Víctor M.

doi:10.1210/jc.2008-0104

Cited by 1,422 publications

(1,376 citation statements)

References 122 publications

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“…36 Correct diagnosis and treatment of PA can not only lead to cure of hypertension in patients with unilateral forms of PA, but can also prevent and reverse organ deterioration independent of aldosterone effects on BP. 37 The prevalence of PA is similar in men and women, but estrogen and progesterone can affect aldosterone and renin levels and, consequently, can interfere with the investigation of PA.…”

Section: Secondary Hypertension In Womenmentioning

confidence: 99%

Hypertension in women

Pimenta

2011

Hypertens Res

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Hypertension is an important modifiable risk factor for cardiovascular (CV) morbidity and mortality, and a highly prevalent condition in both men and women. However, the prevalence of hypertension is predicted to increase more among women than men. Combined oral contraceptives (COCs) can induce hypertension in a small group of women and, increase CV risk especially among those with hypertension. Both COC-related increased CV risk and blood pressure (BP) returns to pretreatment levels by 3 months of its discontinuation. The effects of menopause and hormone replacement therapy (HRT) on BP are controversial, and COCs and HRT containing the new generation progestin drospirenone are preferred in women with established hypertension. Despite the high incidence of cancer in women, CV disease remains the major cause of death in women and comparable benefit of antihypertensive treatment have been demonstrated in both women and men. Hypertension Research (2012) 35, 148-152; doi:10.1038/hr.2011; published online 1 December 2011Keywords: blood pressure; treatment; women INTRODUCTIONHypertension is an important modifiable risk factor for cardiovascular (CV) morbidity and mortality, and a highly prevalent condition in both men and women. Blood pressure (BP) is generally higher in men than in women regardless of age. Mean systolic BP in the overall population increases progressively throughout adult life in both men and women. During early adulthood mean systolic BP is higher in men than women, but the subsequent rate of rise in BP is steeper for women than men. Prevalence and severity of hypertension increase markedly with advancing age in women, such that a higher percentage of women than men have high BP after 65 years. 1-5 Furthermore, BP control is more difficult to achieve in older women. Data from the Framingham Heart Study showed gender differences in BP control rates and in the pattern of antihypertensive medications prescribed. 3 An age-related decrease in BP control rates were more pronounced in women than in men. Among the oldest participants with hypertension, only 23% of women (vs. 38% of men) were controlled to BP o140/90 mm Hg. Treatment with thiazide diuretics was also more frequent among women than men (38 vs. 23%). It is unknown whether the age-related decline in BP control among women is related to true treatment resistance because of biological factors or to inappropriate drug choices in the clinical setting.This article discusses practical aspects related to hypertension in women and some topics are discussed in detail in separate articles in this special review edition.

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Section: Secondary Hypertension In Womenmentioning

confidence: 99%

Hypertension in women

Pimenta

2011

Hypertens Res

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“…1 Using the aldosteroneto-renin ratio (ARR) as a screening tool, several studies found that PA is more frequent than previously assumed, affecting 1-13% of hypertensive individuals. [2][3][4][5][6] The different frequency found in these studies is because of the use of different screening tools, study designs and various study populations.…”

Section: Introductionmentioning

confidence: 99%

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

et al. 2010

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It is suggested to use the aldosterone-to-renin ratio (ARR) as a first test in the screening for primary aldosteronism (PA). However, many groups rather rely on the determination of urinary tetrahydroaldosterone secretion; others calculate a ratio of urinary aldosterone to plasma renin activity. The aim of the present study was to evaluate the usefulness of different parameters of aldosterone excess in the case finding of PA. The study included 28 patients with PA and 33 subjects with essential hypertension. Clinical data, which included the hormonal parameters, serum aldosterone, plasma renin concentration, urinary free aldosterone and metabolites and serum and urinary electrolyte levels were analyzed. These indices of aldosterone excess, the ARR, serum sodium to urinary sodium to (serum potassium) 2 to urinary potassium (SUSPPUP) ratio and combinations of these parameters were compared between the groups. Receiver-operating curve analysis revealed that the ARR multiplied by the SUSPPUP ratio (ARRÂSUSPPUP) is the most reliable screening test, with a sensitivity of 92.3% and a specificity of 93.9% (cutoff point 199.2 (mmol l À1 ) À1 ). The combination of ARRÂSUSPPUP ratio with urinary free aldosterone divided by the plasma renin concentration rendered a specificity of 100%. Less useful was the correction of urinary free aldosterone and its metabolites for sodium excretion. Although the ARR and urinary free aldosterone divided by renin are good tests in the screening for PA, the combination of ARR with SUSPPUP ratio is a better indicator of an aldosterone excess and aldosterone action in patients with ongoing antihypertensive medication. Antihypertensive drugs only marginally interfere with the SUSPPUP ratio, but they may influence the ARR, whereby the effects in PA patients seem to be negligible.

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“…PA was diagnosed in accordance with the cutoff established in our laboratory and the Endocrine Society Practice Guidelines aldosterone concentration (ARR > 12 ng/l/μU/ml and aldosterone concentration > 50 ng/l after saline infusion) [7]. Seventy-nine patients with suspected PA were assessed by a saline infusion test prospectively.…”

Section: Patients and Test Conditionsmentioning

confidence: 99%

“…The test was performed under standardized test conditions if primary aldosteronism was suspected as outlined in the Clinical Practice Guidelines [7]. Potassium was supplemented when the potassium concentration was below 3.5 mmol/l and interfering antihypertensive medication was changed to non-dihydropyridin calcium channel blockers and alpha-blockers whenever possible.…”

Section: Sodium Infusion Testmentioning

confidence: 99%

“…Aldosterone excess is caused primarily by aldosterone producing unilateral adenomas (APA) and bilateral adrenal hyperplasia (BAH) [5]. Most commonly, the diagnosis is established by an elevated plasma aldosteronerenin-ratio (ARR) and a pathologic confir matory test such as the saline infusion test [6,7]. Unilateral adrenalectomy is the treatment of choice for aldosterone producing adenomas, while treatment with mineralocorticoid antagonists is recommended in bilateral disease [8,9].…”

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The Clinical Value of Salivary Aldosterone in Diagnosis and Follow-Up of Primary Aldosteronism

et al. 2016

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Primary aldosteronism (PA), the most common form of secondary hypertension, causes relevant morbidity. The value of salivary measurements of aldosterone in clinical routine in PA so far has not been assessed. First, we analyzed salivary and plasma aldosterone concentrations of 42 patients with PA and 37 hypertensive controls (HC) during a sodium infusion test prospectively. Second, morning salivary and plasma aldosterone concentrations as well as diurnal saliva aldosterone profiles were analyzed in 115 patients treated for PA (46 adrenalectomy, 56 spironolactone, 13 eplerenone). Salivary aldosterone was substantially elevated in PA patients compared to HC at baseline (106?119 vs. 40?21?ng/l, p=0.01), and after 4-h sodium infusion test (60?36 vs. 23?14, p=0.01). Positive correlation between salivary and plasma aldosterone levels was evident, with exception of concentrations in or below the lower normal range. Applying a salivary aldosterone cutoff of 51.2?ng/l, found by ROC curve analysis, rendered a sensitivity of 81% and a specificity of 73% for PA. The diurnal rhythm of aldosterone was preserved in untreated PA patients, but concentrations were higher in the context of PA, and normalized after surgery (118?57 vs. 31?18?ng/l, p<0.01). Taken together, salivary aldosterone measurements correlate with plasma levels, allowing simple and cost effective assessments of aldosterone secretion in an outpatient setting. Nevertheless, as this method alone cannot replace other plasma parameters, and as aldosterone profiling would not alter diagnostic or treatment strategies, salivary aldosterone measurements in routine practice are of limited clinical value.

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Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline

Cited by 1,422 publications

References 122 publications

Hypertension in women

Hypertension in women

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

The Clinical Value of Salivary Aldosterone in Diagnosis and Follow-Up of Primary Aldosteronism

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