Prevalence of Primary Aldosteronism Across the Stages of Hypertension Based on a New Combined Overnight Test

Abstract

Primary aldosteronism (PA) is the most common endocrine cause of arterial hypertension. Despite the increasing incidence of hypertension worldwide, the true prevalence of PA in hypertension was only recently recognized. The objective of the work was to estimate the prevalence of PA in patients at different stages of hypertension based on a newly developed screening-diagnostic overnight test. This is a prospective study with hypertensive patients (n=265) at stage I (n=100), II (n=88), and III (n=77) of hypertension. A group of 103 patients with essential hypertension without PA was used as controls. PA diagnosis was based on a combined screening-diagnostic overnight test, the Dexamethasone-Captopril-Valsartan Test (DCVT) that evaluates aldosterone secretion after pharmaceutical blockade of angiotensin-II and adrenocorticotropic hormone. DCVT was performed in all participants independently of the basal aldosterone to renin ratio (ARR). The calculated upper normal limits for post-DCVT aldosterone levels [3 ng/dl (85 pmol/l)] and post-DCVT ARR [0.32 ng/dl/μU/ml (9 pmol/IU)] from controls, were applied together to establish PA diagnosis. Using these criteria PA was confirmed in 80 of 265 (30%) hypertensives. The prevalence of PA was: 21% (21/100) in stage I, 33% (29/88) in stage II, and 39% (30/77) in stage III. Serum K+ levels were negatively correlated and urinary K+ was positively correlated in PA patients with post-DCVT ARR (r=–0.349, p <0.01, and r=0.27, p <0.05 respectively). In conclusion, DCVT revealed that PA is a highly prevalent cause of hypertension. DCVT could be employed as a diagnostic tool in all subjects with arterial hypertension of unknown cause.

Comparison of two instruments for hypertension self‐care assessments among older adults from China

“…The mean age and duration of hypertension were 73.74 (SD = 8.97) years (range, 60–93) and 14.28 (SD = 11.57) years (range, 1 month to 64 years), respectively. Eighteen respondents (8.18%) had stage I hypertension (SBP 140–159 mmHg and/or DBP 90–99 mmHg), 60 (27.27%) had stage II hypertension (SBP 160–179 mmHg and/or DBP 100–109 mmHg), and 142 (64.55%) had stage III hypertension (SBP ≥180 mmHg and/or DBP≥110 mmHg) (Voulgaris et al, 2021 ). Considering ESCA as a gold standard, 129 participants were defined as having a high level of self‐care, and 91 participants were defined as having a middle‐low level of self‐care.…”

“…The patients who agreed to participate received a questionnaire covering sociodemographic and clinical information, the SC‐HI scale, the HBP SCP scale and the ESCA scale. According to patients' blood pressure value, as defined by the European Society of Hypertension (ESH), their hypertension was categorized into three stages: stage I hypertension (systolic BP [SBP] 140–159 mmHg and/or diastolic BP [DBP] 90–99 mmHg), stage II hypertension (SBP 160–179 mmHg and/or DBP 100–109 mmHg) and stage III hypertension (SBP≥180 mmHg and/or DBP≥110 mmHg) (Liu, 2011; Voulgaris et al, 2021). This study was approved by the Institutional Review Board of the hospital affiliated with Nantong University (Nantong University Ethical Review 2016‐K142).…”

High Prevalence of Primary Aldosteronism in Patients with Type 2 Diabetes Mellitus and Hypertension

“…By contrast, in our study we used a highly sensitive and specific diagnostic test, the DCVT, which is based on the pharmaceutical blockade of both main physiological hormonal stimuli of aldosterone, i.e., renin-angiotensin II and ACTH, and has been validated with an oral saline loading test, the modified FDST [ 16 ]. In addition, DCVT has already been used in previous studies in non-diabetic hypertensive populations with similar results [ 13 ]. The reliability of DCVT is supported by the observation made in this as well as in previous studies, that both post-DCVT aldosterone levels and ARR were negatively correlated with serum K + levels, which are highly dependent on aldosterone action.…”

“…This finding is in complete agreement with the well-known fact that ACTH is a significant stimulating factor of aldosterone secretion and supports our decision to incorporate into the DCVT—apart from the ACE-I and AT1-blockade—dexamethasone, in order to both block RAAS activity and simultaneously suppress the circulating ACTH levels. This modification reduces the normal cutoffs and significantly improves the sensitivity of the DCVT leading to detection of milder PA forms and leading, therefore, to a greater prevalence of PA in hypertensive populations [ 12 , 13 , 25 ].…”

“…Although the existing data suggest that aldosterone excess is directly related to abnormalities of the glucose metabolism, data regarding the prevalence of primary aldosteronism (PA) in patients with DM-2 and concurrent hypertension are limited. By contrast, the prevalence of PA has been extensively investigated in unselected hypertensive patients in whom it ranges from 12 to 32%, depending mainly on the severity of hypertension and the diagnostic methodology applied [ 10 , 11 , 12 , 13 , 14 ]. We have shown that 18% of the hypertensive population who suppress aldosterone on standard confirmatory diagnostic tests exhibit aldosterone hypersecretion under conditions of stress, increasing the prevalence of aldosterone excess up to 60% [ 15 ].…”