Characteristics of Primary Aldosteronism in a Hypertensive Cohort From Central China

To validate region-specific diagnostic thresholds and subtype characterization for primary aldosteronism (PA) in Central China.

Clinical data from 75 PA patients and 85 essential hypertension patients were retrospectively analyzed. Serum biochemical parameters (lipid profiles, renal function, and electrolytes) and hypertension-related markers (upright aldosterone-to-renin ratio [ARR], upright renin [Re], upright aldosterone, adrenocorticotropic hormone, and angiotensin II) were compared between groups. PA patients additionally underwent adrenal computed tomography (CT), saline infusion test, captopril challenge test, and adrenal venous sampling (AVS).

PA patients showed elevated maximum diastolic pressure, upright ARR (optimal cutoff > 3.71 [ng/dL]/[ng/L], AUC 0.919), upright PAC, serum sodium levels, and reduced renin/serum potassium levels versus controls (P < .05). Captopril challenge test and saline infusion test exhibited identical positivity (61.9%) but poor concordance (κ = -0.01). CT misclassified 55.6% left-sided lesions as bilateral on AVS, while 37.5% "bilateral" CT findings were unilateral. Right-sided/CT-normal cases showed 100% AVS concordance (n = 2 requires validation). Unilateral PA patients were younger (50.0 vs 61.1 years, P = .027) with lower potassium (3.11 vs 3.53 mmol/L, P = .059).

An upright ARR cutoff of 3.71 optimizes PA screening in Central China hypertensives. CT reliability is limited for left-adrenal lateralization, necessitating AVS. Younger hypokalemic patients warrant prioritized unilateral assessment.