Prevalence of Primary Aldosteronism in an Urban Hypertensive Population

Abstract

Abstract:Objective: To determine the prevalence of Primary Aldosteronism (PA) in hypertensive patients presenting to the primary care clinic at The Mount Sinai Hospital, regardless of the degree of hypertension and to identify clinical criteria that should prompt screening for PA.Methods: An ARR (cutoff ≥20, with PAC ≥ 10 and suppressed renin) was used to prospectively screen 296 hypertensive patients (BP ≥ 140/90) over the age of 18 from August 2012 through May 2013.Subjects who screened positive then underwent confirmatory oral salt load testing (OSLT).Results: Of the 296 patients, fourteen screened positive for PA, an overall prevalence of 4.7%. Six of the fourteen cases underwent confirmatory OSLT upon which two confirmed positive, prevalence of 0.7%.Overall, patients with confirmed PA were more likely to have resistant hypertension (42.9% vs. 18.1% (p= 0.0334)) and require more anti-hypertensive agents (2.8 ±1.2 agents vs 2.1 ± 1.1 agents (p=0.0213)).There was a trend toward lower potassium values in the cases.Conclusion: The prevalence of PA in our clinic is much lower than in reports from certain "at-risk" populations. PA screening is indicated in patients with resistant hypertension, regardless of serum potassium levels. Introduction:

Prevalence, diagnosis and outcomes of treatment for primary aldosteronism

“…Käyser et al [33] systematically reviewed 39 studies comprising 42510 patients with 36614 patients from hypertension units (26 studies) and 5896 patients from primary care 13 studies) and reported a prevalence of PA in hypertension referral centres ranging from 0.7% to 29.8% and from 3.2% to 12.7% in primary care. An additional 9 studies on the prevalence of PA in referred patients have since been published [33,[46][47][48][49][50][51][52][53][54], bringing the median prevalence of PA in 55045 referred patients with hypertension in all 36 studies to date to 7.0%.…”

Primary Aldosteronism Prevalence – An Unfolding Story

“…Although reports of PA prevalence among patients with hypertension have been heterogeneous due to the vast differences in PA definition between studies, findings consistently suggest that PA prevalence increases in parallel with hypertension severity, ranging from 11–22% in the individual with treatment-resistant hypertension ( Table 1 ) 14 27 36 41 42 43 44 45 46 . On average, only under 3–4% of individuals with treatment-resistant hypertension are screened for PA 14 16 47 48 .…”

Improving Detection Rates for Primary Aldosteronism

“…However, over the past three decades, substantial evidence has emerged showing that PA is more common than initially thought. Studies conducted in the primary care setting with the aim of actively looking for PA have reported a prevalence of 3 to 14% ( Table 1 ) 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 . The prevalence estimates vary depending on the diagnostic threshold used to define PA, with more stringent thresholds unsurprisingly associated with a lower prevalence 27 .…”