Study Heterogeneity and Estimation of Prevalence of Primary Aldosteronism: A Systematic Review and Meta-Regression Analysis

Käyser, Sabine; Dekkers, Tanja; Groenewoud, Hans; Wilt, Gert Jan van der; Bakx, J.C.; Wel, M.C. van der; Hermus, A.R.M.M.; Lenders, Jacques W.M.; Deinum, Jaap

doi:10.1210/jc.2016-1472

Cited by 299 publications

(244 citation statements)

References 73 publications

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“…In particular, 12 studies have been conducted on patients from primary care centers (10,20,21), which represent an apparently unselected hypertensive population, reporting a wide variation in PA prevalence, ranging between 3.2% and 13%. Nevertheless, as suggested by the heterogeneity of the results, these studies could have been biased by the various criteria adopted for patient selection and diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Manifestations of Primary Aldosteronism Encountered in Primary Care Practice

Monticone

Burrello

Tizzani

et al. 2017

Journal of the American College of Cardiology

628

433

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Background. Despite being widely recognized as the most common form of secondary hypertension, the true prevalence of primary aldosteronism (PA) and its main subtypes, aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH), among the general hypertensive population remains a matter of debate. Objectives. To determine the prevalence and clinical phenotype of PA in a large cohort of unselected hypertensive patients, consecutively referred to our Hypertension Unit, by 19 general practitioners from Torino, Italy. Methods. Patients were screened for PA using the serum aldosterone to plasma renin activity ratio after withdrawal from all interfering medications and PA was diagnosed according to the Endocrine Society guidelines. The diagnosis was confirmed/excluded by an i.v. saline infusion test or captopril challenge test and subtype differentiation was performed by adrenal CT scanning and adrenal vein sampling (AVS) using strict criteria to define both successful cannulation and lateralization of aldosterone production. Results. A total of 1,672 primary care hypertensive patients, 569 newly diagnosed hypertensives and 1,103 patients already diagnosed with arterial hypertension, were included in the study. A total of 99 patients (5.9%) were diagnosed with PA and conclusive subtype differentiation by AVS was made in 91 patients (27 patients with an APA and 64 patients with BAH). The overall prevalence of PA increased with the severity of hypertension, from 3.9% in hypertensives stage I to 11.8% in hypertensives stage III. Patients with PA more frequently displayed target organ damage and cardiovascular events compared to non-PA hypertensives, independent of confounding variables. Conclusions.The results from the present study demonstrated that PA is a frequent cause of secondary hypertension even in the general hypertensive population and indicates that the majority of hypertensive patients should be screened for PA. Keywords: Primary aldosteronism, aldosterone-producing adenoma, bilateral adrenal hyperplasiaAbbreviation list AC = aldosterone concentration APA = aldosterone-producing adenoma AVS = adrenal vein sampling ARR = serum aldosterone to plasma renin activity ratio BAH = bilateral adrenal hyperplasia CV events = cardiovascular events GP = general practitioner HT = hypertension LREH = low renin essential hypertensives MRA= mineralocorticoid receptor antagonist PA = primary aldosteronism PATO = primary aldosteronism in Torino Condensed AbstractThe prevalence of primary aldosteronism (PA) among general hypertensive population remains unknown. We screened 1,672 primary care hypertensives and 5.9% were diagnosed with PA (27 3 with an aldosterone-producing adenoma and 64 with bilateral adrenal hyperplasia). PA prevalence increased with the severity of hypertension, from 3.9% in hypertensives stage I to 11.8% in stage III. PA patients more frequently displayed target organ damage and cardiovascular events compared to non-PA hypertensives. The study demonstrated that PA is a frequent cause ...

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Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Manifestations of Primary Aldosteronism Encountered in Primary Care Practice

Monticone

Burrello

Tizzani

et al. 2017

Journal of the American College of Cardiology

628

433

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“…The Methodological Evaluation of Observational Research (MORE) checklist [21] was used to verify methodological quality and risk of bias. This checklist was designed for quality and bias assessment in incidence or prevalence studies of chronic diseases, and was previously used in several systematic reviews [22][23][24][25][26][27][28]. Two authors (M.C.B., H.F.L.)…”

Section: Data Extractionmentioning

confidence: 99%

Incidence and Prevalence of Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Systematic Review and Meta-Analysis

et al. 2019

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Background: Prevalence and incidence rates of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are required to determine the impact of CIDP on society. We aimed to estimate the prevalence and incidence of CIDP worldwide and to determine the effect of diagnostic criteria on prevalence and incidence. Method: A systematic review was conducted for all published incidence and prevalence studies on CIDP until May 18, 2017. Methodological quality was assessed using the Methodological Evaluation of Observational Research checklist. We performed a random effect meta-analysis to estimate pooled prevalence and incidence rates. Results: Of the 907 studies, 11 were included in the systematic review, 5 in the meta-analysis of incidence (818 cases; 220,513,514 person-years) and 9 in the meta-analysis of prevalence (3,160 cases; 160,765,325 population). These studies had a moderate quality. The pooled crude incidence rate was 0.33 per 100,000 person-years (95% CI 0.21–0.53; I² = 95.7%) and the pooled prevalence rate was 2.81 per 100,000 (95% CI 1.58–4.39; I² = 99.1%). Substantial heterogeneity in incidence and prevalence across studies seems to be partly explained by using different diagnostic criteria. Conclusion: These findings provide a starting point to estimate the social burden of CIDP and demonstrate the need to reach consensus on diagnostic criteria for CIDP.

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“…1 The prevalence of primary aldosteronism is reported as 5% in the general hypertensive population, 2 increasing to 10% in referred populations and 15–20% in patients with treatment-resistant hypertension, 3 although estimates vary widely. 4 Several studies have shown a higher prevalence of cardiovascular and cerebrovascular morbidity and mortality in patients with primary aldosteronism than in patients with primary hypertension matched for age, sex, and blood pressure, 5–8 with resolution of excess risk after surgical or specific medical treatment. 9–10 As such, early diagnosis and appropriate treatment of primary aldosteronism are essential to minimise the increased risk associated with this disorder.…”

Section: Introductionmentioning

confidence: 99%

Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort

Williams

Lenders

Mulatero

et al. 2017

The Lancet Diabetes & Endocrinology

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700

741

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Study Heterogeneity and Estimation of Prevalence of Primary Aldosteronism: A Systematic Review and Meta-Regression Analysis

Cited by 299 publications

References 73 publications

Prevalence and Clinical Manifestations of Primary Aldosteronism Encountered in Primary Care Practice

Prevalence and Clinical Manifestations of Primary Aldosteronism Encountered in Primary Care Practice

Incidence and Prevalence of Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Systematic Review and Meta-Analysis

Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort

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