The Unrecognized Prevalence of Primary Aldosteronism


Primary aldosteronism is a non-suppressible renin-independent aldosterone production that causes hypertension and cardiovascular disease. The objective of this study was to characterize the prevalence of nonsuppressible renin-independent aldosterone production, as well as biochemically overt primary aldosteronism, in relation to blood pressure. Every blood pressure category had a continuum of renin-independent aldosterone production, where greater severity of production was associated with higher blood pressure, kaliuresis, and lower serum potassium levels. Mean adjusted levels of urinary aldosterone were 6.5 μg/24 h (95% CI, 5.2 to 7.7 μg/24 h) in normotension, 7.3 μg/24 h (CI, 5.6 to 8.9 μg/24 h) in stage 1 hypertension, 9.5 μg/24 h (CI, 8.2 to 10.8 μg/24 h) in stage 2 hypertension, and 14.6 μg/24 h (CI, 12.9 to 16.2 μg/24 h) in resistant hypertension; corresponding adjusted prevalence estimates for biochemically overt primary aldosteronism were 11.3% (CI, 5.9% to 16.8%), 15.7% (CI, 8.6% to 22.9%), 21.6% (CI, 16.1% to 27.0%), and 22.0% (CI, 17.2% to 26.8%). The aldosterone–renin ratio had poor sensitivity and negative predictive value for detecting biochemically overt primary aldosteronism. The prevalence of primary aldosteronism is high and largely unrecognized. Beyond this categorical definition of primary aldosteronism, there is a prevalent continuum of renin-independent aldosterone production that parallels the severity of hypertension. These findings redefine the primary aldosteronism syndrome and implicate it in the pathogenesis of “essential” hypertension.

Authors: Jenifer M. Brown, Mohammed Siddiqui, David A. Calhoun, Robert M. Carey, Paul N. Hopkins, Gordon H. Williams, Anand Vaidya
Keywords: aldosterone, hypertension, blood pressure, sodium excretion, primary aldosteronism prevalence Resistant hypertension Potassium Cardiovascular diseases Salts Sensitivity
DOI Number: 10.7326/M20-0065      Publication Year: 2020

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