Prevalence of Primary Aldosteronism in Newly Diagnosed Hypertensive Patients in Primary Care

Abstract

Context: Primary aldosteronism (PA) represents the most frequent cause of an endocrine arterial hypertension. PA is also common in patients with mild forms of hypertension and normokalemia. Objective: Our aim was to identify the prevalence of PA in newly diagnosed hypertensive patients in primary care in Southern Germany. Patients and methods: Newly diagnosed hypertensive patients in 27 primary care centers in Munich agreed to participate to the study. Patients had screening for PA with aldosterone to renin ratio (ARR). In case of elevated ARR, confirmation testing was performed. After diagnosis of PA, subtype differentiation and subsequent therapy of PA was initiated. Results: A total of 235 patients with newly discovered arterial hypertension were initially screened for PA. Of these patients, 35 were excluded because the medication indicated pre-existing treated arterial hypertension or they were on interfering antihypertensive medication. 2.0 % of the patients had hypokalemia at first screening. Of the 200 patients with newly discovered arterial hypertension, 42 had an elevated ARR. The incidence of the presence of a hypokalemia did not differ according to normal or pathological ARR. Nine patients (21 %) did not show up for further testing and were lost to follow-up, 33 patients underwent a saline infusion test. Of these, 11 patients were diagnosed with PA, leading to a prevalence of at least 5.5 % of PA in the collective. None of the diagnosed PA patients was hypokalemic at screening. Conclusion: Our data of untreated newly diagnosed patients with hypertension demonstrates a prevalence of 5.5 % of PA.

The Prevalence of Primary Aldosteronism in Screening Populations: Is Hypokalaemia Important?

“…Our findings raise some interesting comparisons with the observations made by Asbach et al 1 . First, 21.0% of their cohort had a raised ARR on initial screening, compared with 4.8% of our cohort.…”

“…Dear Editor, We read with great interest the article by Asbach et al, 'Prevalence of Primary Aldosteronism in Newly Diagnosed Hypertensive Patients in Primary Care', published in Experimental and Clinical Endocrinology & Diabetes [1]. The authors reported that of 200 patients with newly-diagnosed hypertension in 27 primary care centres, 42 (21.0 %) had an elevated aldosterone-to-renin ratio (ARR), of which 11/33 (33.3 %) were subsequently confirmed to have primary aldosteronism (PA).…”

Prevalence of High Aldosterone-Renin Ratio in Patients With Hypertension in Basrah

“…Primary aldosteronism (PA) is defined as non-suppressible aldosterone secretion causing hypertension, which was regarded as the most common cause of secondary (endocrine) hypertension [1][2][3][4]. The classic type of PA showed hypokalemia associated with hypertension, but this form is seldom seen recently [5,6].…”

Treating Primary Aldosteronism-Induced Hypertension: Novel Approaches and Future Outlooks

“…Screening was higher for patients attending a cardiologist, endocrinologist, or nephrologist ( 41 ). European data, collected from patient cohorts in Germany and Italy where there is higher awareness of PA, still observed screening rates within a primary care setting that were <8% ( 36 , 42 , 43 ). These findings are important because the diagnosis and management of hypertension is mostly undertaken in primary care or by generalists and it is important therefore to understand the roadblocks to screening among these professionals ( Fig.…”