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BY-NC-ND 3.0 license Open Access Published by De Gruyter Open Access April 9, 2010

Prevalence of primary aldosteronism among bulgarian hypertensive patients

  • Joanna Matrozova EMAIL logo , Sabina Zacharieva , Georgi Kirilov and Mihail Boyanov
From the journal Open Medicine

Abstract

Primary aldosteronism (PA) has long been considered a rare disease, but a higher prevalence was suggested recently. The aim of this study was to evaluate the prevalence of PA in a group of Bulgarian hypertensive patients, including patients with adrenal incidentalomas (AI). The aldosterone to renin ratio (ARR)>750 was used as a positive screening test and the Captopril test was performed to confirm the diagnosis. Adrenal CT scan was used to differentiate between the main subtypes of PA- aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). The diagnosis of APA was retrospectively confirmed after surgery. After excluding other forms of endocrine hypertension, except PA, we investigated a total of 472 consecutive hypertensive patients, among them 96 patients with AI. Final diagnosis of PA was reached in 38 patients (8.05%) in the entire hypertensive population and in 12 patients (12.5%) among hypertensive patients with AI. In the group of PA, 15 patients (39.5%) were diagnosed with APA and 23 patients (60.5%) had an IHA. Among all patients with PA 21 (55.3 %) presented with hypokalemia. Our findings of a relatively high prevalence of PA support an early diagnosis of this potentially curable disease, especially in hypertensive patients with AI.

[1] Ganguly A., Primary aldosteronism, N Engl J Med., 1998, 339, 1828–1834 http://dx.doi.org/10.1056/NEJM19981217339250710.1056/NEJM199812173392507Search in Google Scholar PubMed

[2] Mulatero P., Stowasser M., Loh KC., Fardella CE., Gordon RD., Mosso L., et al., Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents, J Clin Endocrinol Metab., 2004, 89, 1045–1050 http://dx.doi.org/10.1210/jc.2003-03133710.1210/jc.2003-031337Search in Google Scholar PubMed

[3] Kaplan NM., Is there an unrecognized epidemic of primary aldosteronism? Con, Hypertension, 2007, 50, 454–458 http://dx.doi.org/10.1161/HYPERTENSIONAHA.106.08612410.1161/HYPERTENSIONAHA.106.086124Search in Google Scholar PubMed

[4] Calhoun D., Is there an unrecognized epidemic of primary aldosteronism? Pro, Hypertension, 2007, 50, 447–453 http://dx.doi.org/10.1161/HYPERTENSIONAHA.106.08611610.1161/HYPERTENSIONAHA.106.086116Search in Google Scholar PubMed

[5] Rossi GP., Boscaro M., Ronconi V., Funder J., Aldosterone as a cardiovascular risk factor, Trends Endocrinol Metab., 2005, 16, 104–107 http://dx.doi.org/10.1016/j.tem.2005.02.01010.1016/j.tem.2005.02.010Search in Google Scholar PubMed

[6] Weinberger MH., Is primary aldosteronism a benign disorder? Old evidence reconfirmed, Am J Hypertens., 2006, 19, 628 http://dx.doi.org/10.1016/j.amjhyper.2006.01.00210.1016/j.amjhyper.2006.01.002Search in Google Scholar PubMed

[7] Milliez P., Girerd X., Plouin PF., Blacher J., Safar ME., Mourad JJ., Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism, J Am Coll Cardiol., 2005, 45, 1243–1248 http://dx.doi.org/10.1016/j.jacc.2005.01.01510.1016/j.jacc.2005.01.015Search in Google Scholar PubMed

[8] Catena C., Colussi G., Nadalini E., Chiuch A., Baroselli S., Lapenna R., Sechi LA., Cardiovascular outcomes in patients with primary aldosteronism after treatment, Arch Intern Med., 2008, 168, 80–85 http://dx.doi.org/10.1001/archinternmed.2007.3310.1001/archinternmed.2007.33Search in Google Scholar PubMed

[9] European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension- European Society of Cardiology guidelines for the management of arterial hypertension, J Hypertens., 2003, 21, 1011–1053 http://dx.doi.org/10.1097/00004872-200306000-0000110.1097/00004872-200306000-00001Search in Google Scholar PubMed

[10] Lim PO., Dow E., Brennan G., Jung RT., MacDonald TM., High prevalence of primary aldosteronism in the Tayside hypertension clinic population, J Hum Hypertens., 2000, 14, 311–315 http://dx.doi.org/10.1038/sj.jhh.100101310.1038/sj.jhh.1001013Search in Google Scholar PubMed

[11] Rossi E., Regolisti G., Negro A., Sani C., Davoli S., Perazzoli F., High prevalence of primary aldosteronism using postcaptopril plasma aldosterone to renin ratio as a screening test among Italian hypertensives, Am J Hypertens., 2002, 15, 896–902 http://dx.doi.org/10.1016/S0895-7061(02)02969-210.1016/S0895-7061(02)02969-2Search in Google Scholar PubMed

[12] Jonsson JR., Klemm SA., Tunny TJ., Stowasser M., Gordon RD., A new genetic test for familial hyperaldosteronism type I aids in the detection of curable hypertension, Biochem Biophys Res Commun., 1995, 207, 565–571 http://dx.doi.org/10.1006/bbrc.1995.122510.1006/bbrc.1995.1225Search in Google Scholar PubMed

[13] Strauch B., Zelinka T., Hampf M., Bernhardt R., Widimsky J Jr., Prevalence of primary hyperaldosteronism in moderate to severe hypertension in the Central Europe region, J Hum Hypertens., 2003, 5, 349–352 http://dx.doi.org/10.1038/sj.jhh.100155410.1038/sj.jhh.1001554Search in Google Scholar PubMed

[14] Fardella CE., Mosso L., Gomez-Sanchez C., Cortes P., Soto J., Gomez L., et al., Primary hyperaldosteronism in essential hypertensives: prevalence, biochemical profile, and molecular biology, J Clin Endocrinol Metab., 2000, 85, 1863–1867 http://dx.doi.org/10.1210/jc.85.5.186310.1210/jc.85.5.1863Search in Google Scholar

[15] Fogari R., Preti P., Zoppi A., Rinaldi A., Fogari E., Mugellini A., Prevalence of primary aldosteronism among unselected hypertensive patients: a prospective study based on the use of an aldosterone/renin ratio above 25 as a screening test, Hypertens Res., 2007, 30, 111–117 http://dx.doi.org/10.1291/hypres.30.11110.1291/hypres.30.111Search in Google Scholar PubMed

[16] Gordon RD., Stowasser M., Tunny TJ., Klemm SA., Rutherford JC., High incidence of primary aldosteronism in 199 patients referred with hypertension, Clin Exp Pharmacol Physiol., 1994, 21, 315–318 http://dx.doi.org/10.1111/j.1440-1681.1994.tb02519.x10.1111/j.1440-1681.1994.tb02519.xSearch in Google Scholar PubMed

[17] Mosso L., Carvajal C., Gonzalez A., Barraza A., Avila F., Montero J., et al., Primary aldosteronism and hypertensive disease, Hypertension, 2003, 42, 161–165 http://dx.doi.org/10.1161/01.HYP.0000079505.25750.1110.1161/01.HYP.0000079505.25750.11Search in Google Scholar PubMed

[18] Rossi GP., Bernini G., Caliumi C., Desideri G., Fabris B., Ferri C., et al., PAPY Study Investigators, A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients, J Am Coll Cardiol., 2006, 48, 2293–2300 http://dx.doi.org/10.1016/j.jacc.2006.07.05910.1016/j.jacc.2006.07.059Search in Google Scholar PubMed

[19] Calhoun DA., Nishizaka MK., Zaman MA., Thakkar RB., Weissmann P., Hyperaldosteronism among black and white subjects with resistant hypertension, Hypertension, 2002, 40, 892–896 http://dx.doi.org/10.1161/01.HYP.0000040261.30455.B610.1161/01.HYP.0000040261.30455.B6Search in Google Scholar PubMed

[20] Rossi GP., Bernini G., Desideri G., Fabris B., Ferri C., Giacchetti G., et al., PAPY Study Participants, Renal damage in primary aldosteronism: results of the PAPY Study, Hypertension, 2006, 48, 232–238 http://dx.doi.org/10.1161/01.HYP.0000230444.01215.6a10.1161/01.HYP.0000230444.01215.6aSearch in Google Scholar PubMed

[21] Conn JW., Hypertension, the potassium ion and impaired carbohydrate tolerance, N Engl J Med., 1965, 273, 1135–1143 http://dx.doi.org/10.1056/NEJM19651118273210610.1056/NEJM196511182732106Search in Google Scholar PubMed

[22] Fallo F., Veglio F., Bertello C., Sonino N., Della Mea P., Ermani M., et al., Prevalence and characteristics of the metabolic syndrome in primary aldosteronism, J Clin Endocrinol Metab., 2006, 91, 454–459 http://dx.doi.org/10.1210/jc.2005-173310.1210/jc.2005-1733Search in Google Scholar PubMed

[23] Campion J., Maestro B., Mata F., Davila N., Carranza MC., Calle C., Inhibition by aldosterone on insulin receptor mRNA levels and insulin binding in U-937 human promonocytic cells, J Steroid Biochem Mol Biol., 1999, 70, 211–218 http://dx.doi.org/10.1016/S0960-0760(99)00117-X10.1016/S0960-0760(99)00117-XSearch in Google Scholar PubMed

[24] Williams JS., Williams GH., Raji A., Jeunemaitre X., Brown NJ., Hopkins PN., Conlin PR., Prevalence of primary hyperaldosteronism in mild to moderate hypertension without hypokalaemia, J Hum Hypertens., 2006, 20, 129–136 http://dx.doi.org/10.1038/sj.jhh.100194810.1038/sj.jhh.1001948Search in Google Scholar PubMed

[25] Hiramatsu K., Yamada T., Yukimura Y., Komiya I., Ichikawa K., Ishihara M., et al., A screening test to identify aldosterone-producing adenoma by measuring plasma renin activity. Results in hypertensive patients, Arch Intern Med., 1981, 141, 1589–1593 http://dx.doi.org/10.1001/archinte.141.12.158910.1001/archinte.141.12.1589Search in Google Scholar

[26] Gallay BJ., Ahmad S., Xu L., Toivola B., Davidson RC., Screening for primary aldosteronism without discontinuing hypertensive medications: plasma aldosterone-renin ratio, Am J Kidney Dis., 2001, 37, 699–705 http://dx.doi.org/10.1016/S0272-6386(01)80117-710.1016/S0272-6386(01)80117-7Search in Google Scholar PubMed

[27] Mulatero P., Rabbia F., Milan A., Paglieri C., Morello F., Chiandussi L., Veglio F., Drug effects on aldosterone/plasma renin activity ratio in primary aldosteronism, Hypertension, 2002, 40, 897–902 http://dx.doi.org/10.1161/01.HYP.0000038478.59760.4110.1161/01.HYP.0000038478.59760.41Search in Google Scholar

[28] Plouin PF., About an epidemic of primary aldosteronism, Hypertension, 2008, 51, e6 http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.10444810.1161/HYPERTENSIONAHA.107.104448Search in Google Scholar PubMed

[29] Schwartz GL., Turner ST., Screening for primary aldosteronism in essential hypertension: diagnostic accuracy of the ratio of plasma aldosterone concentration to plasma renin activity, Clin Chem., 2005, 51, 386–394 http://dx.doi.org/10.1373/clinchem.2004.04178010.1373/clinchem.2004.041780Search in Google Scholar PubMed

[30] Castro OL., Yu X., Kem DC., Diagnostic value of the post-captopril test in primary aldosteronism, Hypertension, 2002, 39, 935–938 http://dx.doi.org/10.1161/01.HYP.0000014324.68506.CA10.1161/01.HYP.0000014324.68506.CASearch in Google Scholar

[31] Mulatero P., Bertello C., Garrone C., Rossato D., Mengozzi G., Verhovez A., et al., Captopril test can give misleading results in patients with suspect primary aldosteronism, Hypertension, 2007, 50, e26–27 http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.09346810.1161/HYPERTENSIONAHA.107.093468Search in Google Scholar PubMed

[32] Rossi GP., Belfiore A., Bernini G., Desideri G., Fabris B., Ferri C., et al., Primary Aldosteronism Prevalence in Italy Study Investigators, Comparison of the captopril and the saline infusion test for excluding aldosterone-producing adenoma, Hypertension, 2007, 50, 424–431 http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.09182710.1161/HYPERTENSIONAHA.107.091827Search in Google Scholar PubMed

[33] Rossi GP., Sacchetto A., Chiesura-Corona M., De Toni R., Gallina M., Feltrin GP., Pessina AC., Identification of the etiology of primary aldosteronism with adrenal vein sampling in patients with equivocal computed tomography and magnetic resonance findings: results in 104 consecutive cases, J Clin Endocrinol Metab., 2001, 86, 1083–1090 http://dx.doi.org/10.1210/jc.86.3.108310.1210/jc.86.3.1083Search in Google Scholar

[34] Young WF., Stanson AW., Thompson GB., Grant CS., Farley DR., van Heerden JA., Role for adrenal venous sampling in primary aldosteronism, Surgery, 2004, 136, 1227–1235 http://dx.doi.org/10.1016/j.surg.2004.06.05110.1016/j.surg.2004.06.051Search in Google Scholar PubMed

[35] Funder JW., Carey RM., Fardella C., Gomez-Sanchez CE., Mantero F., Stowasser M., et al.; Endocrine Society, Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline, J Clin Endocrinol Metab., 2008, 93, 3266–3281 http://dx.doi.org/10.1210/jc.2008-010410.1210/jc.2008-0104Search in Google Scholar PubMed

[36] Young WF., Primary aldosteronism: renaissance of a syndrome, Clin Endocrinol (Oxf)., 2007, 66, 607–618 http://dx.doi.org/10.1111/j.1365-2265.2007.02775.x10.1111/j.1365-2265.2007.02775.xSearch in Google Scholar PubMed

[37] Blumenfeld JD., Sealey JE., Schlussel Y., Vaughan ED Jr., Sos TA., Atlas SA., et al., Diagnosis and treatment of primary hyperaldosteronism, Ann Intern Med., 1994, 121, 877–885 10.7326/0003-4819-121-11-199412010-00010Search in Google Scholar PubMed

Published Online: 2010-4-9
Published in Print: 2010-6-1

© 2010 Versita Warsaw

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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