Prevelence of Primary Aldosteronism in an Urban Hypertensive Population |
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| Affiliation: | 1. From the Endocrine and Diabetes Specialists of CT, PriMed Physicians, a member of Northeast Medical Group, Yale New Haven Health, Trumbull, Connecticut;2. Divisions of Endocrinology, Diabetes and Bone Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.;3. Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.;4. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.;5. Department of Surgery, Mount Sinai Beth Israel, The Adrenal Center, Icahn School of Medicine at Mount Sinai, New York, New York.;1. VA San Diego Healthcare System, San Diego, California;2. Department of Medical and Surgical Science, University of Bologna, Italy;1. School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan;2. Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan;3. Management Office for Health Data, China Medical University Hospital, Taichung 40447, Taiwan |
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| Abstract: | Objective: To determine the prevalence of primary aldosteronism (PA) in hypertensive patients presenting to the primary care clinic at The Mount Sinai Hospital, regardless of the degree of hypertension and to identify clinical criteria that should prompt screening for PA.Methods: An aldosterone:renin ratio (ARR, cutoff ≥20, with plasma aldosterone concentration [PAC] ≥10 and suppressed renin) was used to prospectively screen 296 hypertensive patients (blood pressure [BP] ≥140/90) over the age of 18 from August 2012 through May 2013. Subjects who screened positive then underwent confirmatory oral salt load testing (OSLT).Results: Of the 296 patients, 14 screened positive for PA, an overall prevalence of 4.7%. Six of the 14 cases underwent confirmatory OSLT, upon which 2 were confirmed positive, for a prevalence of 0.7%. Overall, patients with confirmed PA were more likely to have resistant hypertension (42.9% vs. 18.1% (P =.0334)) and require more antihypertensive agents (2.8 ± 1.2 agents vs. 2.1 ± 1.1 agents, P =.0213). There was a trend toward lower potassium values in the cases.Conclusion: The prevalence of PA in our clinic is much lower than in reports from certain “at-risk” populations. PA screening is indicated in patients with resistant hypertension, regardless of serum potassium levels.Abbreviations:ARR = aldosterone:renin ratioACTH = adrenocorticotropic hormoneAVS = adrenal venous samplingBP = blood pressureMRA = mineralocorticoid receptor antagonistOSLT = oral salt load confirmatory testPA = primary aldosteronismPAC = plasma aldosterone concentrationPCP = primary care providerPRA = plasma renin activity |
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