RT Journal Article
SR Electronic
T1 Prevalence of primary aldosteronism in primary care: a cross-sectional study
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e114
OP e122
DO 10.3399/bjgp18X694589
VO 68
IS 667
A1 Sabine C Käyser
A1 Jaap Deinum
A1 Wim JC de Grauw
A1 Bianca WM Schalk
A1 Hans JHJ Bor
A1 Jacques WM Lenders
A1 Tjard R Schermer
A1 Marion CJ Biermans
YR 2018
UL http://bjgp.org/content/68/667/e114.abstract
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.