Prevalence of and risk factors for primary aldosteronism among patients with resistant hypertension in China

Xiao-jing, Sang; Jiang, Yiran; Wang, Weiqing; Yan, Li; Zhao, Jiajia; Peng, Yongde; Gu, Wei; Chen, Gang; Liu, Wei; Ning, Guang

doi:10.1097/hjh.0b013e328360ddf6

Cited by 69 publications

(37 citation statements)

References 24 publications

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“…Among patients with resistant hypertension, 5–13% have PA4041. An important implication on clinical practice from these findings is that early diagnosis and early treatment of PA are essential for well controlling BP with tapering antihypertensive medications.…”

Section: Discussionmentioning

confidence: 99%

Long term outcome of Aldosteronism after target treatments

Wang

Chang

et al. 2016

Sci Rep

112

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There exists a great knowledge gap in terms of long-term effects of various surgical and pharmacological treatments on outcomes among primary aldosteronism (PA) patients. Using a validated algorithm, we extracted longitudinal data for all PA patients diagnosed in 1997–2010 and treated in the Taiwan National Health Insurance. We identified 3362 PA patients for whom the mean length of follow-up was 5.75 years. PA has higher major cardiovascular events (MACE) than essential hypertension (23.3% vs 19.3%, p = 0.015). Results from the Cox model suggest a strong effect of adrenalectomy on lowering mortality (HR = 0.23 with residual hypertension and 0.21 with resolved hypertension). While need for receptor antagonist (MRA) MRA after diagnosis suggests that a defined daily dose (DDD) of MRA between 12.5 and 50 mg may alleviate risk of death in a U-shape pattern. A specificity test identified patients who has aldosterone producing adenoma (HR = 0.50, p = 0.005) also confirmed adrenalectomy attenuated all-cause mortality. Adrenalectomy decreases long-term all-cause mortality independently from PA cure from hypertension. Prescription corresponding to a DDD between 12.5 and 50 mg may decrease mortality for patients needing MRA. It calls for more attention on early diagnosis, early treatment and prescription of appropriate dosage of MRA for PA patients.

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Section: Discussionmentioning

confidence: 99%

Long term outcome of Aldosteronism after target treatments

Wang

Chang

et al. 2016

Sci Rep

112

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“…PA is one of the most common identifiable causes of TRH . The prevalence of PA was reported to be between 1% and 10% in uncomplicated hypertension and between 7% and 20% in patients with resistant hypertension . The wide range of prevalence of PA may be related to the study design or population studied.…”

Section: Discussionmentioning

confidence: 99%

“…Primary aldosteronism (PA), one of the most common causes of treatment‐resistant hypertension (TRH), has been identified in up to 20% of patients with TRH seen in tertiary hypertension centers . TRH patients with medication nonadherence (ie, pseudo‐TRH) are presumed to have a lower prevalence of PA than those with true TRH.…”

mentioning

confidence: 99%

“…Primary aldosteronism (PA), one of the most common causes of treatment-resistant hypertension (TRH), has been identified in up to 20% of patients with TRH seen in tertiary hypertension centers. [1][2][3][4] TRH patients with medication nonadherence (ie, pseudo-TRH) are presumed to have a lower prevalence of PA than those with true TRH. Consequently, the 2008 American Heart Association (AHA) position statement recommends investigation for PA, or other causes of secondary hypertension, in patients with apparent TRH after nonadherence to medications is excluded.…”

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confidence: 99%

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Cost‐Effectiveness of Therapeutic Drug Monitoring in Diagnosing Primary Aldosteronism in Patients With Resistant Hypertension

Velasco

Chung

Raza

et al. 2015

J of Clinical Hypertension

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Primary aldosteronism (PA) is present in up to 20% of patients with treatment resistant hypertension (TRH). Investigation for PA in TRH is recommended by the current guidelines after medication nonadherence is excluded. Studies using therapeutic drug monitoring (TDM) have shown more than 50% of patients with TRH are nonadherent to their prescribed antihypertensive medications. However, the relationship between the prevalence of PA and medication adherence as confirmed by TDM has not been previously assessed. A retrospective analysis from our hypertension referral clinic showed that prevalence of PA in adherent TRH patients by TDM was significantly higher than in nonadherent patients (28% vs. 8%, p<0.05). Furthermore, a cost analysis showed that TDM-guided PA screening was $590.69 less expensive per patient, with minimal impact on the diagnostic accuracy. Our data supports a TDM-guided PA screening approach as a cost saving strategy compared to routine PA screening for TRH.

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“…1 The recently investigated prevalence of PA in the Chinese population is 7.1% within refractory hypertension, and within this the proportion of hypokalemia is up to 52.54%. 2 PA comprises a wide spectrum of conditions ranging from a solitary unilateral nodule producing aldosterone to bilateral diffuse or nodular hyperplasia, with several intermediate phenotypes. Two major causes of PA are recognized: idiopathic hyperaldosteronism (IHA), accounting for 60-70% of patients with PA, and aldosterone-producing adenoma (APA), accounting for 30-35%.…”

Section: Introductionmentioning

confidence: 99%

Association of polymorphisms in AGTR1 and AGTR2 genes with primary aldosteronism in the Chinese Han population

Huang

Zhou

et al. 2014

J Renin Angiotensin Aldosterone Syst

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Hypothesis: Polymorphisms in angiotensin II type-1/2 receptor genes (AGTR1/AGTR2) may be involved in the pathogenesis of primary aldosteronism. The present study aims to reveal some loci susceptible to the disease on the genes in a group of Chinese Han nationality. Materials and methods: A case-control study was conducted in 202 patients and 188 controls. Ten tagging SNPs on AGTR1/AGTR2 were genotyped for all subjects via the method of multiplex PCR-ligase detection reaction. Statistical analysis was performed with chi-square test and logistic regression analysis. Results: rs3772616 on the AGTR1 gene was a factor for susceptibility to primary aldosteronism (p<0.001), and the TT genotype significantly decreased the risk of primary aldosteronism compared with the CC homozygote (p=0.008, adjusted OR=0.13; 95%CI: 0.03–0.59). The rs3772616 polymorphism was associated with primary aldosteronism under the additive and dominant models. The female carriers of the G allele in rs5193 showed a significant difference compared with the T allele. Conclusions: The AGTR1 rs3772616 polymorphism can be considered as a hereditary marker for primary aldosteronism, and in the Chinese Han population the rs5193 G allele seems to predispose to it only in women.

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Prevalence of and risk factors for primary aldosteronism among patients with resistant hypertension in China

Abstract: The prevalence of primary aldosteronism among Chinese patients with resistant hypertension is relatively lower than that reported previously for other ethnic populations. The screening for primary aldosteronism should be focused on those with early onset hypertension and/or hypokalemia.

Cited by 69 publications

References 24 publications

Long term outcome of Aldosteronism after target treatments

Long term outcome of Aldosteronism after target treatments

Cost‐Effectiveness of Therapeutic Drug Monitoring in Diagnosing Primary Aldosteronism in Patients With Resistant Hypertension

Association of polymorphisms in AGTR1 and AGTR2 genes with primary aldosteronism in the Chinese Han population

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