Are Idiopathic Hyperaldosteronism and Low-Renin Hypertension Variants of Essential Hypertension?

Abstract

Most diseases are recognised by clinical, chemical, radiological, or pathological features present in that disease but not in other diseases or in normal people. Pernicious anaemia, cancer, stroke, and tuberculosis are diagnosed in this way. Essential hypertension is unusual in that apart from raised arterial pressure it has no characteristic or positive features. Diagnosis is reached negatively by exclusion of alternative diagnoses. A normal intravenous pyelogram is needed because an abnormal result suggests a renal cause for hypertension. Normal cortisol, catecholamines, aldosterone, and renin exclude other secondary forms of hypertension. This process of elimination would be justified if all patients excluded suffered from a disease qualitatively different from essential hypertension. We suggest here that two of the conditions excluded are not and that their exclusion alters the investigator's view of essential hypertension. The evidence is based partly on a recent analysis (Davies et al., 1979) and partly on other work.