Prevalence of primary aldosteronism among bulgarian hypertensive patients

• Autorzy: Joanna Matrozova , Sabina Zacharieva , Georgi Kirilov , Mihail Boyanov
• Języki publikacji: EN

Abstrakty

EN

Primary aldosteronism (PA) has long been considered a rare disease, but a higher prevalence was suggested recently. The aim of this study was to evaluate the prevalence of PA in a group of Bulgarian hypertensive patients, including patients with adrenal incidentalomas (AI). The aldosterone to renin ratio (ARR)>750 was used as a positive screening test and the Captopril test was performed to confirm the diagnosis. Adrenal CT scan was used to differentiate between the main subtypes of PA- aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). The diagnosis of APA was retrospectively confirmed after surgery. After excluding other forms of endocrine hypertension, except PA, we investigated a total of 472 consecutive hypertensive patients, among them 96 patients with AI. Final diagnosis of PA was reached in 38 patients (8.05%) in the entire hypertensive population and in 12 patients (12.5%) among hypertensive patients with AI. In the group of PA, 15 patients (39.5%) were diagnosed with APA and 23 patients (60.5%) had an IHA. Among all patients with PA 21 (55.3 %) presented with hypokalemia. Our findings of a relatively high prevalence of PA support an early diagnosis of this potentially curable disease, especially in hypertensive patients with AI.

Słowa kluczowe

EN

Hypertension; Primary aldosteronism; Prevalence; Aldosterone/renin ratio

• Czasopismo: Open Medicine
• Rocznik: 2010
• Tom: 5
• Numer: 3
• Strony: 399-405

Daty

wydano

2010-06-01

online

2010-04-09

Twórcy

autor

Joanna Matrozova

• Clinical Centre of Endocrinology, Medical University, 1431, Sofia, Bulgaria,

autor

Sabina Zacharieva

• Clinical Centre of Endocrinology, Medical University, 1431, Sofia, Bulgaria

autor

Georgi Kirilov

• Clinical Centre of Endocrinology, Medical University, 1431, Sofia, Bulgaria

autor

Mihail Boyanov

• Alexandrovska Hospital, Department of Endocrinology, Medical University, 1431, Sofia, Bulgaria

Bibliografia

• [1] Ganguly A., Primary aldosteronism, N Engl J Med., 1998, 339, 1828–1834 http://dx.doi.org/10.1056/NEJM199812173392507[Crossref]
• [2] Mulatero P., Stowasser M., Loh KC., Fardella CE., Gordon RD., Mosso L., et al., Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents, J Clin Endocrinol Metab., 2004, 89, 1045–1050 http://dx.doi.org/10.1210/jc.2003-031337[Crossref]
• [3] Kaplan NM., Is there an unrecognized epidemic of primary aldosteronism? Con, Hypertension, 2007, 50, 454–458 http://dx.doi.org/10.1161/HYPERTENSIONAHA.106.086124[Crossref][WoS]
• [4] Calhoun D., Is there an unrecognized epidemic of primary aldosteronism? Pro, Hypertension, 2007, 50, 447–453 http://dx.doi.org/10.1161/HYPERTENSIONAHA.106.086116[WoS][Crossref]
• [5] Rossi GP., Boscaro M., Ronconi V., Funder J., Aldosterone as a cardiovascular risk factor, Trends Endocrinol Metab., 2005, 16, 104–107 http://dx.doi.org/10.1016/j.tem.2005.02.010[Crossref]
• [6] Weinberger MH., Is primary aldosteronism a benign disorder? Old evidence reconfirmed, Am J Hypertens., 2006, 19, 628 http://dx.doi.org/10.1016/j.amjhyper.2006.01.002[Crossref]
• [7] Milliez P., Girerd X., Plouin PF., Blacher J., Safar ME., Mourad JJ., Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism, J Am Coll Cardiol., 2005, 45, 1243–1248 http://dx.doi.org/10.1016/j.jacc.2005.01.015[Crossref]
• [8] Catena C., Colussi G., Nadalini E., Chiuch A., Baroselli S., Lapenna R., Sechi LA., Cardiovascular outcomes in patients with primary aldosteronism after treatment, Arch Intern Med., 2008, 168, 80–85 http://dx.doi.org/10.1001/archinternmed.2007.33[Crossref]
• [9] European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension- European Society of Cardiology guidelines for the management of arterial hypertension, J Hypertens., 2003, 21, 1011–1053 http://dx.doi.org/10.1097/00004872-200306000-00001[Crossref]
• [10] Lim PO., Dow E., Brennan G., Jung RT., MacDonald TM., High prevalence of primary aldosteronism in the Tayside hypertension clinic population, J Hum Hypertens., 2000, 14, 311–315 http://dx.doi.org/10.1038/sj.jhh.1001013[Crossref]
• [11] Rossi E., Regolisti G., Negro A., Sani C., Davoli S., Perazzoli F., High prevalence of primary aldosteronism using postcaptopril plasma aldosterone to renin ratio as a screening test among Italian hypertensives, Am J Hypertens., 2002, 15, 896–902 http://dx.doi.org/10.1016/S0895-7061(02)02969-2[Crossref]
• [12] Jonsson JR., Klemm SA., Tunny TJ., Stowasser M., Gordon RD., A new genetic test for familial hyperaldosteronism type I aids in the detection of curable hypertension, Biochem Biophys Res Commun., 1995, 207, 565–571 http://dx.doi.org/10.1006/bbrc.1995.1225[Crossref]
• [13] Strauch B., Zelinka T., Hampf M., Bernhardt R., Widimsky J Jr., Prevalence of primary hyperaldosteronism in moderate to severe hypertension in the Central Europe region, J Hum Hypertens., 2003, 5, 349–352 http://dx.doi.org/10.1038/sj.jhh.1001554[Crossref]
• [14] Fardella CE., Mosso L., Gomez-Sanchez C., Cortes P., Soto J., Gomez L., et al., Primary hyperaldosteronism in essential hypertensives: prevalence, biochemical profile, and molecular biology, J Clin Endocrinol Metab., 2000, 85, 1863–1867 http://dx.doi.org/10.1210/jc.85.5.1863[Crossref]
• [15] Fogari R., Preti P., Zoppi A., Rinaldi A., Fogari E., Mugellini A., Prevalence of primary aldosteronism among unselected hypertensive patients: a prospective study based on the use of an aldosterone/renin ratio above 25 as a screening test, Hypertens Res., 2007, 30, 111–117 http://dx.doi.org/10.1291/hypres.30.111[Crossref][WoS]
• [16] Gordon RD., Stowasser M., Tunny TJ., Klemm SA., Rutherford JC., High incidence of primary aldosteronism in 199 patients referred with hypertension, Clin Exp Pharmacol Physiol., 1994, 21, 315–318 http://dx.doi.org/10.1111/j.1440-1681.1994.tb02519.x[Crossref]
• [17] Mosso L., Carvajal C., Gonzalez A., Barraza A., Avila F., Montero J., et al., Primary aldosteronism and hypertensive disease, Hypertension, 2003, 42, 161–165 http://dx.doi.org/10.1161/01.HYP.0000079505.25750.11[Crossref]
• [18] Rossi GP., Bernini G., Caliumi C., Desideri G., Fabris B., Ferri C., et al., PAPY Study Investigators, A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients, J Am Coll Cardiol., 2006, 48, 2293–2300 http://dx.doi.org/10.1016/j.jacc.2006.07.059
• [19] Calhoun DA., Nishizaka MK., Zaman MA., Thakkar RB., Weissmann P., Hyperaldosteronism among black and white subjects with resistant hypertension, Hypertension, 2002, 40, 892–896 http://dx.doi.org/10.1161/01.HYP.0000040261.30455.B6[Crossref]
• [20] Rossi GP., Bernini G., Desideri G., Fabris B., Ferri C., Giacchetti G., et al., PAPY Study Participants, Renal damage in primary aldosteronism: results of the PAPY Study, Hypertension, 2006, 48, 232–238 http://dx.doi.org/10.1161/01.HYP.0000230444.01215.6a[Crossref][WoS]
• [21] Conn JW., Hypertension, the potassium ion and impaired carbohydrate tolerance, N Engl J Med., 1965, 273, 1135–1143 http://dx.doi.org/10.1056/NEJM196511182732106[Crossref]
• [22] Fallo F., Veglio F., Bertello C., Sonino N., Della Mea P., Ermani M., et al., Prevalence and characteristics of the metabolic syndrome in primary aldosteronism, J Clin Endocrinol Metab., 2006, 91, 454–459 http://dx.doi.org/10.1210/jc.2005-1733[Crossref]
• [23] Campion J., Maestro B., Mata F., Davila N., Carranza MC., Calle C., Inhibition by aldosterone on insulin receptor mRNA levels and insulin binding in U-937 human promonocytic cells, J Steroid Biochem Mol Biol., 1999, 70, 211–218 http://dx.doi.org/10.1016/S0960-0760(99)00117-X[Crossref]
• [24] Williams JS., Williams GH., Raji A., Jeunemaitre X., Brown NJ., Hopkins PN., Conlin PR., Prevalence of primary hyperaldosteronism in mild to moderate hypertension without hypokalaemia, J Hum Hypertens., 2006, 20, 129–136 http://dx.doi.org/10.1038/sj.jhh.1001948[Crossref]
• [25] Hiramatsu K., Yamada T., Yukimura Y., Komiya I., Ichikawa K., Ishihara M., et al., A screening test to identify aldosterone-producing adenoma by measuring plasma renin activity. Results in hypertensive patients, Arch Intern Med., 1981, 141, 1589–1593 http://dx.doi.org/10.1001/archinte.141.12.1589[Crossref]
• [26] Gallay BJ., Ahmad S., Xu L., Toivola B., Davidson RC., Screening for primary aldosteronism without discontinuing hypertensive medications: plasma aldosterone-renin ratio, Am J Kidney Dis., 2001, 37, 699–705 http://dx.doi.org/10.1016/S0272-6386(01)80117-7[Crossref]
• [27] Mulatero P., Rabbia F., Milan A., Paglieri C., Morello F., Chiandussi L., Veglio F., Drug effects on aldosterone/plasma renin activity ratio in primary aldosteronism, Hypertension, 2002, 40, 897–902 http://dx.doi.org/10.1161/01.HYP.0000038478.59760.41[Crossref]
• [28] Plouin PF., About an epidemic of primary aldosteronism, Hypertension, 2008, 51, e6 http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.104448[Crossref][WoS]
• [29] Schwartz GL., Turner ST., Screening for primary aldosteronism in essential hypertension: diagnostic accuracy of the ratio of plasma aldosterone concentration to plasma renin activity, Clin Chem., 2005, 51, 386–394 http://dx.doi.org/10.1373/clinchem.2004.041780[Crossref]
• [30] Castro OL., Yu X., Kem DC., Diagnostic value of the post-captopril test in primary aldosteronism, Hypertension, 2002, 39, 935–938 http://dx.doi.org/10.1161/01.HYP.0000014324.68506.CA[Crossref]
• [31] Mulatero P., Bertello C., Garrone C., Rossato D., Mengozzi G., Verhovez A., et al., Captopril test can give misleading results in patients with suspect primary aldosteronism, Hypertension, 2007, 50, e26–27 http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.093468[WoS][Crossref]
• [32] Rossi GP., Belfiore A., Bernini G., Desideri G., Fabris B., Ferri C., et al., Primary Aldosteronism Prevalence in Italy Study Investigators, Comparison of the captopril and the saline infusion test for excluding aldosterone-producing adenoma, Hypertension, 2007, 50, 424–431 http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.091827[Crossref]
• [33] Rossi GP., Sacchetto A., Chiesura-Corona M., De Toni R., Gallina M., Feltrin GP., Pessina AC., Identification of the etiology of primary aldosteronism with adrenal vein sampling in patients with equivocal computed tomography and magnetic resonance findings: results in 104 consecutive cases, J Clin Endocrinol Metab., 2001, 86, 1083–1090 http://dx.doi.org/10.1210/jc.86.3.1083
• [34] Young WF., Stanson AW., Thompson GB., Grant CS., Farley DR., van Heerden JA., Role for adrenal venous sampling in primary aldosteronism, Surgery, 2004, 136, 1227–1235 http://dx.doi.org/10.1016/j.surg.2004.06.051[Crossref]
• [35] Funder JW., Carey RM., Fardella C., Gomez-Sanchez CE., Mantero F., Stowasser M., et al.; Endocrine Society, Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline, J Clin Endocrinol Metab., 2008, 93, 3266–3281 http://dx.doi.org/10.1210/jc.2008-0104[Crossref]
• [36] Young WF., Primary aldosteronism: renaissance of a syndrome, Clin Endocrinol (Oxf)., 2007, 66, 607–618 http://dx.doi.org/10.1111/j.1365-2265.2007.02775.x[Crossref]
• [37] Blumenfeld JD., Sealey JE., Schlussel Y., Vaughan ED Jr., Sos TA., Atlas SA., et al., Diagnosis and treatment of primary hyperaldosteronism, Ann Intern Med., 1994, 121, 877–885 [Crossref]

Identyfikatory

DOI

10.2478/s11536-010-0005-x