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Comparing ARR Versus Suppressed PRA as Screening Tests for Primary Aldosteronism.

Hypertension (Dallas, Tex. : 1979)·2024

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Primary Aldosteronism: Where Are We Now? Where to From Here?

Hypertension (Dallas, Tex. : 1979)·2022

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A Novel Method: Super-selective Adrenal Venous Sampling

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Who and How Should We Screen for Primary Aldosteronism?

John W Funder¹

¹Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia.

Hypertension (Dallas, Tex. : 1979)

|October 6, 2023

Summary

This summary is machine-generated.

Primary aldosteronism (PA) affects 30% of hypertensive patients, posing a higher risk than essential hypertension. Screening all hypertension patients with spironolactone and blood pressure response is recommended for early PA detection and management.

Keywords:

established hypertension hyperaldosteronism newly presenting hypertension spironolactone

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Published on: December 4, 2016

Area of Science:

Endocrinology
Cardiovascular Medicine
Public Health

Background:

Primary aldosteronism (PA) is increasingly recognized as a significant contributor to hypertension, affecting at least 30% of screened patients.
Patients with PA exhibit a substantially higher risk profile compared to essential hypertensives, even with similar blood pressure levels.
Current screening rates for PA in hypertensive individuals remain critically low, below 1%.

Purpose of the Study:

To highlight the underdiagnosis of primary aldosteronism (PA) in hypertensive populations.
To propose a simple and effective screening method for PA applicable to all hypertensive patients.
To underscore the public health implications of widespread, undiagnosed PA.

Main Methods:

Administering spironolactone 25 mg/day for 4 weeks to hypertensive patients.
Monitoring blood pressure response to spironolactone as a diagnostic indicator for PA.
Comparing blood pressure changes in established and newly presenting hypertension cases.

Main Results:

A blood pressure fall of <10 mm Hg suggests PA is unlikely, while a fall >12 mm Hg indicates probable PA.
The proposed screening protocol is effective for both established and newly diagnosed hypertension.
The study anticipates identifying a significant number of hypertensive patients with PA, likely predominantly bilateral disease.

Conclusions:

A simple spironolactone challenge test can effectively screen all hypertensive patients for PA.
The high prevalence and underdiagnosis of PA represent a major public health concern.
Timely identification and management of PA are crucial for mitigating cardiovascular risk in hypertensive patients.