Historical changes and between-facility differences in adrenal venous sampling for primary aldosteronism in Japan


Primary aldosteronism (PA) is a common curable cause of hypertension. Adrenal venous sampling (AVS) is recommended for subtype diagnosis but is a difficult procedure. Recently, an increased prevalence of PA was reported, creating a greater demand for treatment of the condition in clinical facilities. The aim of the present study was to identify the historical changes over time and the differences between facilities in the success rate and subtype diagnosis of PA. The database of the PA registry developed by the Japan PA Study (JPAS) was used. A total of 2599 patients with PA who underwent AVS were evaluated. The overall success rate of AVS was 88%. The bilateral subtype was the dominant subtype, comprising 69% of cases. During the period 2004−2011 to 2011−2017, there were significant changes in the total number of AVS procedures (from 562 to 1732), ratio of ACTH administration with AVS (75 to 97%), success rate (79 to 90%), and proportion with bilateral subtype diagnosis (53 to 72%). There were also significant inter-facility differences in the number of AVS procedures (6 to 322), success rate (59 to 97%), and proportion with the bilateral subtype (44 to 86%). The principal enrolled department was Endocrinology (86%), and the ratio of unilateral PA was significantly higher in this department than in others (32% vs. 25%). In conclusion, the number of AVS procedures performed, the success rate, and the proportion with the bilateral subtype increased over time after normalizing the centre difference. Significant differences were observed between the centres.

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This study was conducted as a part of the JPAS and JRAS by a Research Grant from the Japan Agency for Medical Research and Development (AMED) under Grant Number JP17ek0109122,JP18ek0109352, and JP19ek0109352, andthe National Center for Global Health and Medicine, Japan (27-1402, 30-1008). We wish to thank Dr. Yukio Hirata at the Institute of Biomedical Research and Innovation Hospital and Dr. Kazuaki Shimamoto at Sapporo Medical University School of Medicine for interpreting the significance of the results of this study. We also wish to thank Dr. Masanobu Yamada at Gunma University, Tatsuya Kai at Saiseikai Tondabayashi Hospital, Ryuichi Sakamoto at Saiseikai Fukuoka Hospital for collecting the clinical data.

JPAS Study Group

Masanobu Yamada28, Hiromi Rakugi29, Takashi Kawamura30, Osamu Ogawa31, Toshinari Yamasaki31, Akiyo Tanabe32, Tomonobu Hasegawa33, Masanori Abe34, Ryuichi Sakamoto35, Takuro Shinbo36, Tatsuya Kai37, Tomikazu Fukuoka38, Masanori Murakami39, Shigeatsu Hashimoto40, Makito Tanabe41, Mitsuhiro Kometani42, Yuichirou Yoshikawa43, Youichi Oono44, Hisashi Fukuda45, Takashi Yoneda46, Touru Sugiyama47, Fumihiko Matsuda48, Takahisa Kawaguchi48

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Correspondence to Yuichi Fujii.

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Members of the JPAS Study Group are listed at the end of the paper.

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Fujii, Y., Takeda, Y., Kurihara, I. et al. Historical changes and between-facility differences in adrenal venous sampling for primary aldosteronism in Japan. J Hum Hypertens 34, 34–42 (2020). https://doi.org/10.1038/s41371-019-0229-4

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