Hypertension may not increase risk for primary aldosteronism
People with hypertension may not be at increased risk for primary aldosteronism compared with people without hypertension; however, people with resistant hypertension should be screened for primary aldosteronism, recent study data suggest.
“In our particular population, we did not find the prevalence of disease that has been demonstrated in other studies,” Sandi Jo Galati, MD, clinical endocrinology at Endocrine and Diabetes Specialists of CT, PriMed Physicians, told Endocrine Today. “This suggests there are other underlying predisposing factors to disease presence which need to be elucidated. Several familial causes of primary aldosteronism have been described, but are rare. The disparity in disease prevalence between our population and the European population suggests there are other genetic and epigenetic factors at play.”
Sandi Jo Galati
Galati and colleagues evaluated data from 296 adults with hypertension, defined as two blood pressure measurements of more than 140/90 mm Hg or current treatment with antihypertensive medications, recruited from a primary care clinic at Mount Sinai Hospital between August 2012 and May 2013.
Elevated plasma aldosterone concentration and aldosterone:renin ratio suggestive of primary aldosteronism was present in 14 participants (cases), for an overall prevalence of 4.7% on initial testing. Six of these participants underwent an oral salt-load confirmatory test, and there were two confirmed positive cases of primary aldosteronsim for a prevalence of 0.7%.
Compared with participants screening negative for primary aldosteronism (controls), cases had significantly higher plasma aldosterone concentration levels (P < .001) and significantly lower plasma renin activity levels (P < .0463).
Compared with controls, cases were more likely to have resistant hypertension (P = .0334) and were more likely to require more anti-hypertensive agents (P = .0213).
“We know that the prevalence of primary aldosteronism has been demonstrated to be upwards of 10% in some study populations and also higher in hypertensive patients with certain other co-existing diseases such as diabetes and obstructive sleep apnea,” Galati told Endocrine Today. “Moving forward, we need to determine what populations are at highest risk for primary aldosteronism so that these patients can be screened early and effectively for this potentially curable disease.” – by Amber Cox
For more information:
Sandi Jo Galati, MD, can be reached at firstname.lastname@example.org.
Disclosure: Galati reports being a consultant for Corcept Therapeutics.