PA is Under-Treated

Surgical treatment offers significant improvement, if not complete resolution of symptoms, in 35% of patients affected by primary aldosteronism. In the remaining 65%, medical therapy helps mitigate the damage caused by excess aldosterone. Yet, less than 8% of those affected are ever treated. Regardless of the limitations of current diagnosis and treatment modalities, appropriate management of the disease calls for an appropriate framing of the problem: excess aldosterone is a major public health issue.

Aldosteronism word map

High Prevalence

Under-use of available means is compounded by high prevalence: at a minimum, 10 million people are affected in the US, and 250 million worldwide. Medical issues of this magnitude are, by definition, public health issues. Their resolution requires concerted efforts only public health agencies can successfully deploy and monitor.

Wide-Ranging Damage

Excess aldosterone is associated with at least a dozen other diseases, some of which are fatal. By mitigating conditions such as diabetes and chronic heart failure, timely treatment of primary aldosteronism is de facto a preventative public health measure. More importantly, since it is now known that excess aldosterone is actually a primary cause of hypertension, treating hyperaldosteronism helps adequately address another major public health issue – essential hypertension.

Dietary Sodium

Despite being well-known, the role of dietary sodium in hypertension is not systematically emphasized. The cardiovascular damage of excess aldosterone is largely driven by inappropriate levels of sodium. Public health interventions are needed not only to promote healthy choices, but to make them the easiest choices. Successfully addressing the importance of dietary sodium requires interventions on a scale comparable to that of smoking cessation measures.

Racial and Gender Factors

Not only are African Americans at higher risk of developing hypertension, they are more likely to develop primary aldosteronism. Yet, they receive poorer healthcare, and are largely underrepresented in clinical trials. The impact of gender on the disease is equally critical. For example, when present during pregnancy, it causes maternal and fetal complications. These factors remain largely overlooked, and warrant proper interventions at the public health level.

Healthcare Spending

The wider socio-economic costs of under-treating primary aldosteronism are as damaging as its distressing impact on individuals, families, and communities. Adrenal venous sampling and adrenalectomies may come at a price for healthcare systems, and while more affordable, medical treatment is less effective. However, when taking prevalence and burden of disease into consideration, the financial consequences of under-treating primary aldosteronism far exceed those of available options. In the US alone, the cost of cardiovascular disease was estimated at $219 billion in 2015, and the total cost of diabetes reached $327 billion in 2017.

Magnifying glass and document

References

  • John W. Funder, Commentary: Primary aldosteronism as a public health issue, Lancet, Vol 4, Issue 12, P972-973, Dec 01, 2016, DOI: 10.1016/S2213-8587(16)30272-8
  • Libianto, R., Fuller, P.J., Young, M.J. et al. Primary aldosteronism is a public health issue: challenges and opportunities. J Hum Hypertens 34, 478–486 (2020). DOI: 10.1038/s41371-020-0336-2
  • National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), US Centers for Disease Control and Prevention, Health and Economic Costs of Chronic Diseases, https://www.cdc.gov/chronicdisease/about/costs/index.htm
  • Dieleman JL, Cao J, Chapin A, et al. US Health Care Spending by Payer and Health Condition, 1996-2016. JAMA. 2020;323(9):863–884. DOI: 10.1001/jama.2020.0734
  • Gregory L Hundemer,  Prof Gary C Curhan, Nicholas Yozamp,  Molin Wang, Anand Vaidya, Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study, The Lancet, Volume 6, Issue 1, P51-59, January 01, 2018, DOI: 10.1016/S2213-8587(17)30367-4
  • Paul Millier, Xavier Girerd, Pierre-François Plouin, Jacques Blacher, Michel E.Safar, Jean-Jacques Mourad, Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism, Journal of the American College of Cardiology, Volume 45, Issue 8, 19 April 2005, Pages 1243-1248, DOI: 10.1016/j.jacc.2005.01.015
  • Dena E. Rifkin, Ali R. Khaki, Nancy S. Jenny, Robyn L. McClelland, Matthew Budoff, Karol Watson, Joachim H. Ix, Matthew A. Allison, Association of Renin and Aldosterone With Ethnicity and Blood Pressure: The Multi-Ethnic Study of Atherosclerosis, American Journal of Hypertension, Volume 27, Issue 6, June 2014, Pages 801–810, DOI: 10.1093/ajh/hpt276

©2021 Primary Aldosteronism Foundation — All Rights Reserved

The Primary Aldosteronism Foundation is a registered 501(c)(3) public charity. Donations are tax deductible in the US.

©2021 Primary Aldosteronism Foundation

The Primary Aldosteronism Foundation is a registered 501(c)(3) public charity. Donations are tax deductible in the US.