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Prevalence of primary aldosteronism and screening indications
1Consultant, Endocrine Hypertension Clinic, Endocrinology Department, Fundación Jiménez Diaz University Hospital, Madrid, Spain.
Introduction:
Primary aldosteronism (PA) is a common yet underrecognized cause of secondary hypertension. Once identified as Conn's syndrome with hypokalemia and adrenal tumors, PA now includes broader forms with inappropriate aldosterone secretion and low renin. Despite its link to cardiovascular risk, under 15 percent of eligible patients are screened, leading to underestimated prevalence and missed treatment chances. Main Section: Improved assays and awareness reveal PA is more frequent than believed, often without hypokalemia and even in normotensive patients. Meta-analyses show PA prevalence of 6.8-10 percent in hypertensive groups, rising over 50 percent in resistant hypertension. Diagnostic and population differences cause varied detection, highlighting the need for standard screening. PA rates might increase in patients with higher reno-cardiometabolic compromise. Aldosterone excess promotes cardiovascular remodeling and arrhythmias, so early PA diagnosis in these groups can improve outcomes. Although current guidelines recommend broad screening for PA, particularly in high-risk patients, there is a growing trend toward universal screening in all individuals with hypertension. PA also occurs in mild or normotensive individuals (>10 percent prevalence), so many hypertensives qualify for screening. Adhering to guidelines supports screening nearly all hypertensives for timely diagnosis and treatment.
Conclusions:
PA is a common, clinically important yet often missed cause of hypertension, affecting resistant, mild, and normotensive cases. It is prevalent among those patients with cardiovascular complications. Guidelines, though recommending targeted screening, effectively endorse broad testing to enhance detection. Expanding screening and standardizing diagnostics are crucial to optimize diagnosis, enable tailored therapy, reduce cardiovascular risk, and improve outcomes.
Insights
Primary aldosteronism (PA) is a frequent cause of hypertension, often missed in diagnosis. Broad screening is recommended to improve early detection and treatment of PA, reducing cardiovascular risks.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Hypertension Research
Background:
- Primary aldosteronism (PA) is an underrecognized cause of secondary hypertension, often missed due to broader presentations beyond classic Conn's syndrome.
- Despite its significant cardiovascular risks, screening for PA remains low, leading to underestimated prevalence and delayed treatment.
- PA is increasingly recognized in hypertensive, resistant hypertensive, and even normotensive individuals, necessitating broader diagnostic approaches.
Purpose of the Study:
- To highlight the increased prevalence and clinical significance of primary aldosteronism.
- To emphasize the need for expanded screening protocols for PA in various hypertensive patient groups.
- To advocate for standardized diagnostic methods to improve PA detection and management.
Main Methods:
- Review of current literature and meta-analyses on PA prevalence.
- Analysis of diagnostic trends and guideline recommendations for PA screening.
- Evaluation of the impact of aldosterone excess on cardiovascular health.
Main Results:
- PA prevalence is higher than previously thought, affecting 6.8-10% of hypertensive patients and over 50% of those with resistant hypertension.
- PA is prevalent in patients with cardiovascular complications and can occur in mild or normotensive individuals.
- Current guidelines support broad screening for PA, with a trend towards universal screening in all hypertensive individuals.
Conclusions:
- Primary aldosteronism is a common and critical condition often missed, impacting diverse patient populations including those with resistant, mild, and normotensive hypertension.
- The prevalence of PA is significant, particularly in patients with cardiovascular issues, underscoring the importance of timely diagnosis.
- Expanding screening efforts and standardizing diagnostic procedures are essential for optimizing PA management, reducing cardiovascular risk, and improving patient outcomes.
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