Prevalence and Clinical Manifestations of Primary Aldosteronism Encountered in Primary Care Practice
| Autor: | Giulio Mengozzi, Franco Veglio, Luisa Gabetti, Fabrizio Buffolo, Davide Tizzani, Franco Rabbia, A. Viola, Paolo Mulatero, Jacopo Burrello, Chiara Bertello, Tracy Ann Williams, Silvia Monticone |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Pathology hypertension Adenoma Population Secondary hypertension 030209 endocrinology & metabolism 030204 cardiovascular system & hematology Plasma renin activity 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Primary aldosteronism Internal medicine Hyperaldosteronism Prevalence Humans Medicine Stage (cooking) education adrenal vein sampling education.field_of_study Aldosterone Adrenal Hyperplasia Congenital Primary Health Care business.industry bilateral adrenal hyperplasia Middle Aged medicine.disease aldosterone-producing adenoma Phenotype Editorial Italy renin chemistry Adrenocortical Adenoma Captopril challenge test Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of the American College of Cardiology. 69:1811-1820 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2017.01.052 |
| Popis: | Background Despite being widely recognized as the most common form of secondary hypertension, among the general hypertensive population the true prevalence of primary aldosteronism (PA) and its main subtypes, aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH), remains a matter of debate. Objectives This study sought to determine the prevalence and clinical phenotype of PA in a large cohort of unselected patients with hypertension, consecutively referred to our hypertension unit, by 19 general practitioners from Torino, Italy. Methods Following withdrawal from all interfering medications, patients were screened for PA using the ratio of serum aldosterone to plasma renin activity. PA was diagnosed according to Endocrine Society guidelines. The diagnosis was confirmed or excluded by an intravenous saline infusion test or captopril challenge test and subtype differentiation was performed by adrenal computed tomography scanning and adrenal vein sampling, using strict criteria to define successful cannulation and lateralization of aldosterone production. Results A total of 1,672 primary care patients with hypertension (569 newly diagnosed and 1,103 patients already diagnosed with arterial hypertension) were included in the study. A total of 99 patients (5.9%) were diagnosed with PA and conclusive subtype differentiation by adrenal vein sampling was made in 91 patients (27 patients with an APA and 64 patients with BAH). The overall prevalence of PA increased with the severity of hypertension, from 3.9% in stage 1 hypertension to 11.8% in stage 3 hypertension. Patients with PA more frequently displayed target organ damage and cardiovascular events compared with those without PA, independent of confounding variables. Conclusions Our results demonstrated that PA is a frequent cause of secondary hypertension, even in the general population of patients with hypertension, and indicates that most of these patients should be screened for PA. |
| Databáze: | OpenAIRE |
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