Prevalence of primary aldosteronism (PA) may be as high as 4% among Chinese patients newly diagnosed with hypertension, according to a study published April 20 in the Journal of the American College of Cardiology.

Zhixin Xu, MD, looked at the prevalence, characteristics and outcomes of PA in 1,020 patients newly diagnosed with hypertension. Patients with an aldosterone-renin ratio of 20 ng/mIU and plasma aldosterone concentration >10 ng/dL underwent a captopril challenge test and/or saline infusion to confirm PA. Adrenal computed tomography and adrenal vein sampling (AVS) were then used for subtyping. Patients identified with PA were treated either surgically or with medication and followed for 12 months.

According to the results, the average age of patients was 51 years, and 35% were women. A total of 93 patients (9%) were screened positive for PA based on aldosterone-renin ratios and plasma aldosterone concentration. These patients were divided into three groups: 40 who were classified as having PA, 21 classified as non-PA, and 32 classified as probable PA. The overall prevalence of PA was 4%. There was no difference in PA prevalence based on hypertension stage.

Of the 40 patients diagnosed with PA, four underwent AVS – three of whom were confirmed as having unilateral PA and one confirmed as having bilateral PA. At 12 months, four PA patients had been lost to follow up, seven had been treated surgically and 29 were treated with medication. All patients receiving surgical treatment achieved complete biochemical success. In addition, six patients treated surgically achieved complete clinical success, defined as normal blood pressure without antihypertensive medication. Among patients who received medication, 23 (79.3%) achieved optimal blood pressure control. Among these, 21 (91.3%) required one antihypertensive medication.

The study's findings "justify early screening and timely diagnosis as key factors to optimize the clinical prognosis of patients with PA," according to the researchers. PA is "not uncommon" among newly diagnosed hypertensive patients in China, they note, concluding that revised guidelines should focus on early detection of PA and increased awareness of PA as a treatable cause of hypertension.

This study sends the "message loud and clear to primary care practitioners, cardiologists and anyone else who makes an initial diagnosis of hypertension," John W. Funder, MD, PhD, writes in an accompanying editorial comment. "Every such patient should be screened for possible PA," Funder notes, adding "early intervention is extraordinarily successful – across the spectrum of PA, and across the spectrum of blood pressure elevation."

Clinical Topics: Dyslipidemia, Prevention, Lipid Metabolism, Novel Agents, Hypertension

Keywords: Aldosterone, Blood Pressure, Captopril, Antihypertensive Agents, Renin, Hyperaldosteronism, Hypertension, Blood Pressure Determination, China, Cardiology

< Back to Listings