Prevalence, Subtype Classification, and Outcomes of Treatment of Primary Aldosteronism: A Prospective Study in China

Abstract

Objective: To investigate the prevalence of primary aldosteronism (PA) among participants with hypertension, evaluate the concordance of PA classification between adrenal computed tomography and adrenal venous sampling, and compare the outcomes of surgery and medication for unilateral PA. Methods: A prospective study was conducted among all inpatients with hypertension (n ¼ 7594) at the National Center for Cardiovascular Diseases, China, from May 2016 to April 2018. Results: Of the 7594 participants, 8.12% (n ¼ 617) with plasma aldosterone-renin ratio 3.7 were possible PA cases. Three hundred sixty-seven cases with plasma aldosterone-renin ratio 3.7 and plasma aldosterone concentration 10 ng/dL were confirmed using the recumbent saline infusion test (69.20%, 182 of 263) or the captopril challenge test (66.5%, 69 of 104, P > .05). The prevalence of PA was 3.31% (n ¼ 251). Of the 251 patients with PA, all of them had multiple comorbidities, and 49.40% (n ¼ 124) had spontaneous hypokalemia. The concordance of PA classification between adrenal computed tomography and adrenal venous sampling was only 47.11%. The patients' blood pressure declined to normal ranges in the adrenalectomy (85.71%, 30 of 35) and spironolactone (63.04%; 29 of 46) groups (P < .05). Furthermore, hypokalemia was normalized in the adrenalectomy (100.00%; 26 of 26) and spironolactone (94.74%; 18 of 19) groups. Conclusion: It is necessary to incorporate PA screening into routine practice for those with hypertension in the Chinese population. This will assist in ensuring that the best therapeutic schedule based on PA subtypes is devised. Additionally, as a result, it may contribute to restoring the blood pressure levels and reducing the prevalence of comorbidities in these patients with PA.

Use the right kidney contour as a landmark in adrenal vein sampling

“…AVS is the crucial step in the clinical management of PA, which distinguishes unilateral from bilateral adrenal sources of autonomous aldosterone secretion [ 1 , 2 ]. However, the difficulty of AVS is illustrated by low reported success rates of selective cannulation, not even reaching 50% in some centers or registries, that mainly due to great anatomic variations of the RAV in the junction with postcava on the right side [ 9 ].…”

“…CT or MRI examination may not be unreliable to distinguish unilateral from bilateral subtype. Thus, adrenal vein sampling (AVS) has become the gold standard for localizing lesions [ 1 , 2 ].…”

Assessment of biochemical outcomes in patients with primary aldosteronism after adrenalectomy based on CT scan diagnosis of unilateral adenoma without adrenal vein sampling

“…A recent international study showed that hypokalemia was present in 73.9% unilateral PA patients ( 42 ). The Chinese urological guidelines ( 18 ) also recommend that the incidence rate of hypokalemia in primary aldosterone patients is about 50%, and a prospective study of all hypertensive inpatients ( n = 7,594) from May 2016–April 2018 at the National Cardiovascular Center/Fu Wai Hospital in China found that 49.40% ( n = 124) had spontaneous hypokalemia of the 251 patients with PA ( 43 ); meanwhile, another clinical research at the First Affiliated Hospital of Zhejiang University, included 222 patients diagnosed with PA from January 2009 to June 2018, found that 50% ( n = 111) had spontaneous hypokalemia ( 44 ). It may be that the diagnostic criteria of PA varied among countries and hospital or that Asians are more sensitive to aldosterone.…”

Expert opinion. Spironolactone: a new twist on an old story

“…В качестве стандарта для выявления ПА рекомендуется использовать интегрированный метод, оценивающий экскрецию альдостерона с мочой за 24 часа [14]. По данным этого теста распространенность ПА в 3-5 раз превышает общепринятый в настоящее время показатель 3-5 % среди пациентов с АГ [15]. В исследовании Brown JM с соавт.…”