Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2016) 41 S8.2 | DOI: 10.1530/endoabs.41.S8.2

ECE2016 Symposia Primary aldosteronism (3 abstracts)

Revised guidelines for finding and treating primary aldosteronism

Franco Mantero


Italy.


Primary aldosteronism is an endocrine form of hypertension which is highly prevalent among hypertensive population but its rate of detection is far lower than its real prevalence.

This might be due to lack of adequate information or expertise in general practitioners or even among hypertension specialists, other than endocrinologists. As PA is common, and has a much higher cardiovascular risk profile than age-, sex-, and blood pressure (BP)–matched essential hypertension, targeted treatment is of obvious benefit to at-risk patients with hypertension. Thus, the challenge of diagnosing this condition, correctly recognizing the subtype, and offering the optimal specific treatment was faced in 2008 by the Endocrine Society who published Clinical Guidelines for the Case Detection, Diagnosis, and Treatment of Primary Aldosteronism (PA). Since than, new insights in understanding the pathophysiology of PA and better diagnostic methods became available; on the other hand, it was recognized that, in spite of the world-wide diffusion of the Guidelines, an overwhelming majority of PA remain occult since most subjects with PA are never screened. To address these issues, it was decided to update the Guidelines, in the attempt either to incorporating insights from relevant studies over the past seven years but also to offer, in the explicit recognition that PA as a major public health issue, and not merely a matter of complex and expensive case detection, diagnosis and treatment of individual patients, a simplified approach to those hypertensives who are not fortunate enough to be studied in specialized Centers. The new Guidelines, which are expected to appear within the current year, build on and extend the previous ones in several points including: broader indications for screening to include subjects with sustained BP above 150/100 mmHg; recognition that the prevalence of PA varies from 5% (and more APA) to 10% (and more IHA) according as more or less stringent cutoffs for ARR and PAC are adopted; strengthening the case for timely diagnosis and treatment of PA, based on mounting evidence for cardiovascular and renal damage; report of new findings on molecular genetic of APA; suggestion of abbreviated work-up in patients with clear cut signs of PA and definition of the conditions in which AVS could be avoided; indication to tentatively treat with MR antagonist all cases with elevated ARR who are unwilling or unable to proceed in the confirmatory/subtype testing. The Guidelines will end with an outlook on the need of standardized Aldosterone and Renin assays, of more reliable confirmatory tests, of less invasive and more accessible imaging techniques, of new non-steroidal MR antagonists, of institution of registries and, above all, of providing to all clinicians involved in the field the ability to recognize PA as a possible (and treatable) cause of hypertension in their patients.

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