A high prevalence of primary hyperaldosteronism in hypertensive patients
Agnieszka Jagodzinska, Wojciech Zieleniewski & Renata Michalak
Hypertension remains one of the most common diseases affecting more than 25% of the whole population. It is associated with high mortality risk due to cardiovascular complications. Usually hypertension is of idiopathic origin, however, several other diseases, including hormonal abnormalities may cause hypertension.
Here, we present the frequency of primary hyperaldosteronism in a group of 310 hypertensive patients.
Previously, they had excluded other potential causes of hypertension, such as renal diseases, diabetes mellitus, cardiac malformations other hormonal disturbances or drugs affecting blood pressure.
All subjects underwent saline infusion test with determination of plasma aldosterone (RIA assay) and active renin concentration (radioimmunoenzymatic assay) before and after 2.0 l of isotonic standard saline infusion for 4 h i.v). Moreover, they had measured ACTH, cortisol, DHEA-S and chromogranin A concentrations. Ultrasonography was performed in all patients and abdominal CT scan in those with abnormal hormonal results.
Primary hyperaldosteronism was confirmed in 55 patients (18%), 36 women and 19 men. Idiopathic hyperaldosteronism was found in 36 patients (65%), whereas adrenal adenoma in 19 patients (35%). Hypokalaemia was found in 23 patients (42%). Moreover, an aldosterone/active renin ratio above 8.25 strongly suggest the existence of primary hyperaldosteronism.
In conclusion, we suggest screening for hyperaldosteronism in young hypertensive patients with poorly controlled blood pressure with standard antihypertensive therapy and tendency to low kalium concentration.