PT  - JOURNAL ARTICLE
AU  - Sabine C Käyser
AU  - Jaap Deinum
AU  - Wim JC de Grauw
AU  - Bianca WM Schalk
AU  - Hans JHJ Bor
AU  - Jacques WM Lenders
AU  - Tjard R Schermer
AU  - Marion CJ Biermans
TI  - Prevalence of primary aldosteronism in primary care: a cross-sectional study
AID  - 10.3399/bjgp18X694589
DP  - 2018 Feb 01
TA  - British Journal of General Practice
PG  - e114--e122
VI  - 68
IP  - 667
4099  - http://bjgp.org/content/68/667/e114.short
4100  - http://bjgp.org/content/68/667/e114.full
SO  - Br J Gen Pract2018 Feb 01; 68
AB  - Background Primary aldosteronism (PA) is the most frequent cause of secondary hypertension. Reported prevalences of PA vary considerably because of a large heterogeneity in study methodology.Aim To examine the proportion of patients with PA among patients with newly diagnosed, never treated hypertension.Design and setting A cross-sectional study set in primary care.Method GPs measured aldosterone and renin in adult patients with newly diagnosed, never treated hypertension. Patients with elevated aldosterone-to-renin ratio and increased plasma aldosterone concentration underwent a saline infusion test to confirm or exclude PA. The source population was meticulously assessed to detect possible selection bias.Results Of 3748 patients with newly diagnosed hypertension, 343 patients were screened for PA. In nine out of 74 patients with an elevated aldosterone-to-renin ratio and increased plasma aldosterone concentration the diagnosis of PA was confirmed by a saline infusion test, resulting in a prevalence of 2.6% (95% confidence interval = 1.4 to 4.9). All patients with PA were normokalaemic and 8 out of 9 patients had sustained blood pressure >150/100 mmHg. Screened patients were younger (P<0.001) or showed higher blood pressure (P<0.001) than non-screened patients.Conclusion In this study a prevalence of PA of 2.6% in a primary care setting was established, which is lower than estimates reported from other primary care studies so far. This study supports the screening strategy as recommended by the Endocrine Society Clinical Practice Guideline. The low proportion of screened patients (9.2%), of the large cohort of eligible patients, reflects the difficulty of conducting prevalence studies in primary care clinical practice.