In the current issue of the Journal Nicholas Yolamp and his colleagues have published an article entitled “Intraindividual Variability in Aldosterone Concentrations in Primary Aldosteronism: Implications for Case Detection.” Where to from here? First, we need new guidelines, not just for endocrinologists published in the Journal of Clinical Endocrinology and Metabolism, but for internists and primary care providers. Primary care providers commonly are the first point of contact for newly presenting hypertensives; crucially, their first response should not be antihypertensives, but a blood draw for measurement of plasma renin. If plasma renin activity is above 1 ng/mL per hour (or plasma renin concentration above 8 mU/L), onto antihypertensives, diet, and exercise, etc. If plasma renin is suppressed, show the patient how best to collect a 24-hour urine and bring it in for determination of sodium excretion and levels of urinary excretion of aldosterone. If they are below 6 µg/day, onto antihypertensives, and a word about lowering salt intake. If they are between 6 and 12 µg/day—possible primary aldosteronism—onto spironolactone 25 mg/day and check blood pressure after 4 weeks. If they are above 12 mcg/day, the patient has primary aldosteronism.
Authors: John W. Funder
Keywords: case detection, screening, diagnosis, aldosterone renin ratio, plasma aldosterone concentration
DOI Number: 10.1161/HYPERTENSIONAHA.120.16585 Publication Year: 2021
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