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Prevalence of primary hyperaldosteronism in mild to moderate hypertension without hypokalaemia

Journal of Human Hypertension volume 20, pages 129–136 (2006)Cite this article

Abstract

Screening for primary hyperaldosteronism (PHA) is often indicated in individuals with resistant hypertension or hypokalaemia. However, in the far larger subset of the hypertensive population who do not fit into these criteria, the evidence for screening is conflicting and dependent on the disease prevalence. The purpose of this study was to examine the prevalence of PHA in a large population with mild to moderate hypertension and without hypokalaemia using a carefully controlled study protocol including a normotensive control population. Hypertensive subjects underwent medication washout and both hypertensive and normotensive subjects placed on a high-sodium diet prior to biochemical and haemodynamic testing. Study specific cutoff values were based on results from the normotensive population studied under identical conditions. A screening test (serum aldosterone/PRA ratio [ARR]>25 with a serum aldosterone level >8 ng/dl) was followed by a confirmatory test (urine aldosterone excretion rate [AER] >17 μg/24 h) to demonstrate evidence of PHA. An elevated ARR with a concomitant elevated serum aldosterone was present in 26 (7.5%) individuals. Of these, 11 (3.2%) had an elevated AER, consistent with evidence of PHA. Individuals with PHA had higher blood pressure and lower serum potassium levels while on a high-sodium diet. Sodium restriction neutralized these differences between PHA and essential hypertensives. The prevalence of PHA in this mild to moderate hypertensive population without hypokalaemia is at most 3.2%, a rate that might lead to excessive false positives with random screening in comparable populations. Hyperaldosteronism, when present, is responsive to sodium restriction.

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Acknowledgements

This work was supported by the National Institutes of Health grants HL47651, HL59424, HL77234, DK63214, Specialized Center of Research in Hypertension (HL55000), National Center for Research Resources (General Clinical Research Centers) in Boston (M01 RR 02635) and Salt Lake City (M01 RR 00064) and the Department of Veterans Affairs- Health Services Research and Development (TEL-02-100). Dr J Williams was in part supported by a Brigham and Women's Hospital Research Council Dual-mentorship grant. We gratefully acknowledge the assistance of the dietary, nursing, administrative and laboratory staffs of the clinical research centers.

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Authors and Affiliations

  1. Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA

    J S Williams, G H Williams, A Raji & P R Conlin

  2. Centre d'Investigation Clinique 92401 Inserm/AP, Departement de Genetique, Hopital European Georges Pompidou, Paris, France

    X Jeunemaitre

  3. Departments of Medicine and Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA

    N J Brown

  4. Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    P N Hopkins

  5. Medical Service, VA Boston Healthcare System, Boston, MA, USA

    P R Conlin

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  1. J S Williams
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Correspondence to J S Williams.

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Williams, J., Williams, G., Raji, A. et al. Prevalence of primary hyperaldosteronism in mild to moderate hypertension without hypokalaemia. J Hum Hypertens 20, 129–136 (2006). https://doi.org/10.1038/sj.jhh.1001948

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