Horm Metab Res 2021; 53(07): 461-469
DOI: 10.1055/a-1507-5226
Endocrine Care

Prevalence of Primary Aldosteronism Across the Stages of Hypertension Based on a New Combined Overnight Test

1  Department of Endocrinology and Diabetes Center, “G. Gennimatas” General Hospital of Athens, Athens, Greece
2  Department of Endocrinology, Athens Naval and Veterans Hospital, Athens, Greece
,
Ernestini Tyfoxylou
1  Department of Endocrinology and Diabetes Center, “G. Gennimatas” General Hospital of Athens, Athens, Greece
,
Sophia Vlachou
1  Department of Endocrinology and Diabetes Center, “G. Gennimatas” General Hospital of Athens, Athens, Greece
,
Evagelia Kyriazi
1  Department of Endocrinology and Diabetes Center, “G. Gennimatas” General Hospital of Athens, Athens, Greece
,
Chris Gravvanis
1  Department of Endocrinology and Diabetes Center, “G. Gennimatas” General Hospital of Athens, Athens, Greece
,
Chara Kapsali
1  Department of Endocrinology and Diabetes Center, “G. Gennimatas” General Hospital of Athens, Athens, Greece
,
Athina Markou
1  Department of Endocrinology and Diabetes Center, “G. Gennimatas” General Hospital of Athens, Athens, Greece
,
Labrini Papanastasiou
1  Department of Endocrinology and Diabetes Center, “G. Gennimatas” General Hospital of Athens, Athens, Greece
,
Alexandros Gryparis
3  Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieion Hospital, Medical National and Kapodistrian University of Athens, Athens, Greece
,
Eva Kassi
4  Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
5  Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
George Chrousos
6  University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Athens, Greece
,
Gregory Kaltsas
5  Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
George Piaditis
1  Department of Endocrinology and Diabetes Center, “G. Gennimatas” General Hospital of Athens, Athens, Greece
› Author Affiliations

Abstract

Primary aldosteronism (PA) is the most common endocrine cause of arterial hypertension. Despite the increasing incidence of hypertension worldwide, the true prevalence of PA in hypertension was only recently recognized. The objective of the work was to estimate the prevalence of PA in patients at different stages of hypertension based on a newly developed screening-diagnostic overnight test. This is a prospective study with hypertensive patients (n=265) at stage I (n=100), II (n=88), and III (n=77) of hypertension. A group of 103 patients with essential hypertension without PA was used as controls. PA diagnosis was based on a combined screening-diagnostic overnight test, the Dexamethasone-Captopril-Valsartan Test (DCVT) that evaluates aldosterone secretion after pharmaceutical blockade of angiotensin-II and adrenocorticotropic hormone. DCVT was performed in all participants independently of the basal aldosterone to renin ratio (ARR). The calculated upper normal limits for post-DCVT aldosterone levels [3 ng/dl (85 pmol/l)] and post-DCVT ARR [0.32 ng/dl/μU/ml (9 pmol/IU)] from controls, were applied together to establish PA diagnosis. Using these criteria PA was confirmed in 80 of 265 (30%) hypertensives. The prevalence of PA was: 21% (21/100) in stage I, 33% (29/88) in stage II, and 39% (30/77) in stage III. Serum K+ levels were negatively correlated and urinary K+ was positively correlated in PA patients with post-DCVT ARR (r=–0.349, p <0.01, and r=0.27, p <0.05 respectively). In conclusion, DCVT revealed that PA is a highly prevalent cause of hypertension. DCVT could be employed as a diagnostic tool in all subjects with arterial hypertension of unknown cause.

Supplementary Material



Publication History

Received: 16 March 2021

Accepted after revision: 04 May 2021

Publication Date:
19 July 2021 (online)

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