Increased Diagnosis of Primary Aldosteronism, Including Surgically Correctable Forms, in Centers from Five Continents

TLDR

Primary aldosteronism, once thought to affect less than 1 % of hypertensive patients, is now recognized as a common endocrine hypertension, especially after ARR screening revealed a higher prevalence and hypokalemia was no longer considered a prerequisite. The study retrospectively evaluated PA diagnosis across five continents before and after widespread ARR screening. Data were collected from clinical centers worldwide, comparing PA diagnostic rates pre‑ and post‑ARR implementation. Using the ARR as a screening test increased PA detection 5‑ to 15‑fold, with only 9‑37 % of patients hypokalemic, and raised annual APA detection 1.3‑ to 6.3‑fold, especially in centers performing adrenal venous sampling where APA comprised 28‑50 % of PA cases versus 9 % elsewhere.

Abstract

Abstract Primary aldosteronism (PA) is a common form of endocrine hypertension previously believed to account for less than 1% of hypertensive patients. Hypokalemia was considered a prerequisite for pursuing diagnostic tests for PA. Recent studies applying the plasma aldosterone/plasma renin activity ratio (ARR) as a screening test have reported a higher prevalence. This study is a retrospective evaluation of the diagnosis of PA from clinical centers in five continents before and after the widespread use of the ARR as a screening test. The application of this strategy to a greater number of hypertensives led to a 5- to 15-fold increase in the identification of patients affected by PA. Only a small proportion of patients (between 9 and 37%) were hypokalemic. The annual detection rate of aldosterone-producing adenoma (APA) increased in all centers (by 1.3–6.3 times) after the wide application of ARR. Aldosterone-producing adenomas constituted a much higher proportion of patients with PA in the four centers that employed adrenal venous sampling (28–50%) than in the center that did not (9%). In conclusion, the wide use of the ARR as a screening test in hypertensive patients led to a marked increase in the detection rate of PA.