Skip to main content
SpringerLink
Log in

Prevalence of primary aldosteronism among bulgarian hypertensive patients

  • Research Article
  • Published:
Central European Journal of Medicine

Abstract

Primary aldosteronism (PA) has long been considered a rare disease, but a higher prevalence was suggested recently. The aim of this study was to evaluate the prevalence of PA in a group of Bulgarian hypertensive patients, including patients with adrenal incidentalomas (AI). The aldosterone to renin ratio (ARR)>750 was used as a positive screening test and the Captopril test was performed to confirm the diagnosis. Adrenal CT scan was used to differentiate between the main subtypes of PA- aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). The diagnosis of APA was retrospectively confirmed after surgery. After excluding other forms of endocrine hypertension, except PA, we investigated a total of 472 consecutive hypertensive patients, among them 96 patients with AI. Final diagnosis of PA was reached in 38 patients (8.05%) in the entire hypertensive population and in 12 patients (12.5%) among hypertensive patients with AI. In the group of PA, 15 patients (39.5%) were diagnosed with APA and 23 patients (60.5%) had an IHA. Among all patients with PA 21 (55.3 %) presented with hypokalemia. Our findings of a relatively high prevalence of PA support an early diagnosis of this potentially curable disease, especially in hypertensive patients with AI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ganguly A., Primary aldosteronism, N Engl J Med., 1998, 339, 1828–1834

    Article  CAS  PubMed  Google Scholar 

  2. Mulatero P., Stowasser M., Loh KC., Fardella CE., Gordon RD., Mosso L., et al., Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents, J Clin Endocrinol Metab., 2004, 89, 1045–1050

    Article  CAS  PubMed  Google Scholar 

  3. Kaplan NM., Is there an unrecognized epidemic of primary aldosteronism? Con, Hypertension, 2007, 50, 454–458

    Article  CAS  Google Scholar 

  4. Calhoun D., Is there an unrecognized epidemic of primary aldosteronism? Pro, Hypertension, 2007, 50, 447–453

    Article  CAS  Google Scholar 

  5. Rossi GP., Boscaro M., Ronconi V., Funder J., Aldosterone as a cardiovascular risk factor, Trends Endocrinol Metab., 2005, 16, 104–107

    Article  CAS  PubMed  Google Scholar 

  6. Weinberger MH., Is primary aldosteronism a benign disorder? Old evidence reconfirmed, Am J Hypertens., 2006, 19, 628

    Article  PubMed  Google Scholar 

  7. Milliez P., Girerd X., Plouin PF., Blacher J., Safar ME., Mourad JJ., Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism, J Am Coll Cardiol., 2005, 45, 1243–1248

    Article  CAS  PubMed  Google Scholar 

  8. Catena C., Colussi G., Nadalini E., Chiuch A., Baroselli S., Lapenna R., Sechi LA., Cardiovascular outcomes in patients with primary aldosteronism after treatment, Arch Intern Med., 2008, 168, 80–85

    Article  CAS  PubMed  Google Scholar 

  9. European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension- European Society of Cardiology guidelines for the management of arterial hypertension, J Hypertens., 2003, 21, 1011–1053

    Article  Google Scholar 

  10. Lim PO., Dow E., Brennan G., Jung RT., MacDonald TM., High prevalence of primary aldosteronism in the Tayside hypertension clinic population, J Hum Hypertens., 2000, 14, 311–315

    Article  CAS  PubMed  Google Scholar 

  11. Rossi E., Regolisti G., Negro A., Sani C., Davoli S., Perazzoli F., High prevalence of primary aldosteronism using postcaptopril plasma aldosterone to renin ratio as a screening test among Italian hypertensives, Am J Hypertens., 2002, 15, 896–902

    Article  CAS  PubMed  Google Scholar 

  12. Jonsson JR., Klemm SA., Tunny TJ., Stowasser M., Gordon RD., A new genetic test for familial hyperaldosteronism type I aids in the detection of curable hypertension, Biochem Biophys Res Commun., 1995, 207, 565–571

    Article  CAS  PubMed  Google Scholar 

  13. Strauch B., Zelinka T., Hampf M., Bernhardt R., Widimsky J Jr., Prevalence of primary hyperaldosteronism in moderate to severe hypertension in the Central Europe region, J Hum Hypertens., 2003, 5, 349–352

    Article  Google Scholar 

  14. Fardella CE., Mosso L., Gomez-Sanchez C., Cortes P., Soto J., Gomez L., et al., Primary hyperaldosteronism in essential hypertensives: prevalence, biochemical profile, and molecular biology, J Clin Endocrinol Metab., 2000, 85, 1863–1867

    Article  CAS  PubMed  Google Scholar 

  15. Fogari R., Preti P., Zoppi A., Rinaldi A., Fogari E., Mugellini A., Prevalence of primary aldosteronism among unselected hypertensive patients: a prospective study based on the use of an aldosterone/renin ratio above 25 as a screening test, Hypertens Res., 2007, 30, 111–117

    Article  PubMed  Google Scholar 

  16. Gordon RD., Stowasser M., Tunny TJ., Klemm SA., Rutherford JC., High incidence of primary aldosteronism in 199 patients referred with hypertension, Clin Exp Pharmacol Physiol., 1994, 21, 315–318

    Article  CAS  PubMed  Google Scholar 

  17. Mosso L., Carvajal C., Gonzalez A., Barraza A., Avila F., Montero J., et al., Primary aldosteronism and hypertensive disease, Hypertension, 2003, 42, 161–165

    Article  CAS  PubMed  Google Scholar 

  18. Rossi GP., Bernini G., Caliumi C., Desideri G., Fabris B., Ferri C., et al., PAPY Study Investigators, A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients, J Am Coll Cardiol., 2006, 48, 2293–2300

    Article  CAS  PubMed  Google Scholar 

  19. Calhoun DA., Nishizaka MK., Zaman MA., Thakkar RB., Weissmann P., Hyperaldosteronism among black and white subjects with resistant hypertension, Hypertension, 2002, 40, 892–896

    Article  CAS  PubMed  Google Scholar 

  20. Rossi GP., Bernini G., Desideri G., Fabris B., Ferri C., Giacchetti G., et al., PAPY Study Participants, Renal damage in primary aldosteronism: results of the PAPY Study, Hypertension, 2006, 48, 232–238

    Article  CAS  PubMed  Google Scholar 

  21. Conn JW., Hypertension, the potassium ion and impaired carbohydrate tolerance, N Engl J Med., 1965, 273, 1135–1143

    Article  CAS  PubMed  Google Scholar 

  22. Fallo F., Veglio F., Bertello C., Sonino N., Della Mea P., Ermani M., et al., Prevalence and characteristics of the metabolic syndrome in primary aldosteronism, J Clin Endocrinol Metab., 2006, 91, 454–459

    Article  CAS  PubMed  Google Scholar 

  23. Campion J., Maestro B., Mata F., Davila N., Carranza MC., Calle C., Inhibition by aldosterone on insulin receptor mRNA levels and insulin binding in U-937 human promonocytic cells, J Steroid Biochem Mol Biol., 1999, 70, 211–218

    Article  CAS  PubMed  Google Scholar 

  24. Williams JS., Williams GH., Raji A., Jeunemaitre X., Brown NJ., Hopkins PN., Conlin PR., Prevalence of primary hyperaldosteronism in mild to moderate hypertension without hypokalaemia, J Hum Hypertens., 2006, 20, 129–136

    Article  CAS  PubMed  Google Scholar 

  25. Hiramatsu K., Yamada T., Yukimura Y., Komiya I., Ichikawa K., Ishihara M., et al., A screening test to identify aldosterone-producing adenoma by measuring plasma renin activity. Results in hypertensive patients, Arch Intern Med., 1981, 141, 1589–1593

    Article  CAS  PubMed  Google Scholar 

  26. Gallay BJ., Ahmad S., Xu L., Toivola B., Davidson RC., Screening for primary aldosteronism without discontinuing hypertensive medications: plasma aldosterone-renin ratio, Am J Kidney Dis., 2001, 37, 699–705

    Article  CAS  PubMed  Google Scholar 

  27. Mulatero P., Rabbia F., Milan A., Paglieri C., Morello F., Chiandussi L., Veglio F., Drug effects on aldosterone/plasma renin activity ratio in primary aldosteronism, Hypertension, 2002, 40, 897–902

    Article  CAS  PubMed  Google Scholar 

  28. Plouin PF., About an epidemic of primary aldosteronism, Hypertension, 2008, 51, e6

    Article  CAS  PubMed  Google Scholar 

  29. Schwartz GL., Turner ST., Screening for primary aldosteronism in essential hypertension: diagnostic accuracy of the ratio of plasma aldosterone concentration to plasma renin activity, Clin Chem., 2005, 51, 386–394

    Article  CAS  PubMed  Google Scholar 

  30. Castro OL., Yu X., Kem DC., Diagnostic value of the post-captopril test in primary aldosteronism, Hypertension, 2002, 39, 935–938

    Article  CAS  PubMed  Google Scholar 

  31. Mulatero P., Bertello C., Garrone C., Rossato D., Mengozzi G., Verhovez A., et al., Captopril test can give misleading results in patients with suspect primary aldosteronism, Hypertension, 2007, 50, e26–27

    Article  CAS  PubMed  Google Scholar 

  32. Rossi GP., Belfiore A., Bernini G., Desideri G., Fabris B., Ferri C., et al., Primary Aldosteronism Prevalence in Italy Study Investigators, Comparison of the captopril and the saline infusion test for excluding aldosterone-producing adenoma, Hypertension, 2007, 50, 424–431

    Article  CAS  PubMed  Google Scholar 

  33. Rossi GP., Sacchetto A., Chiesura-Corona M., De Toni R., Gallina M., Feltrin GP., Pessina AC., Identification of the etiology of primary aldosteronism with adrenal vein sampling in patients with equivocal computed tomography and magnetic resonance findings: results in 104 consecutive cases, J Clin Endocrinol Metab., 2001, 86, 1083–1090

    Article  CAS  PubMed  Google Scholar 

  34. Young WF., Stanson AW., Thompson GB., Grant CS., Farley DR., van Heerden JA., Role for adrenal venous sampling in primary aldosteronism, Surgery, 2004, 136, 1227–1235

    Article  PubMed  Google Scholar 

  35. Funder JW., Carey RM., Fardella C., Gomez-Sanchez CE., Mantero F., Stowasser M., et al.; Endocrine Society, Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline, J Clin Endocrinol Metab., 2008, 93, 3266–3281

    Article  CAS  PubMed  Google Scholar 

  36. Young WF., Primary aldosteronism: renaissance of a syndrome, Clin Endocrinol (Oxf)., 2007, 66, 607–618

    Article  CAS  Google Scholar 

  37. Blumenfeld JD., Sealey JE., Schlussel Y., Vaughan ED Jr., Sos TA., Atlas SA., et al., Diagnosis and treatment of primary hyperaldosteronism, Ann Intern Med., 1994, 121, 877–885

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinical Centre of Endocrinology, Medical University, 1431, Sofia, Bulgaria

    Joanna A. Matrozova, Sabina Z. Zacharieva & Georgi G. Kirilov

  2. Alexandrovska Hospital, Department of Endocrinology, Medical University, 1431, Sofia, Bulgaria

    Mihail A. Boyanov

Authors
  1. Joanna A. Matrozova
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sabina Z. Zacharieva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Georgi G. Kirilov
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mihail A. Boyanov
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joanna A. Matrozova.

About this article

Cite this article

Matrozova, J.A., Zacharieva, S.Z., Kirilov, G.G. et al. Prevalence of primary aldosteronism among bulgarian hypertensive patients. cent.eur.j.med 5, 399–405 (2010). https://doi.org/10.2478/s11536-010-0005-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2478/s11536-010-0005-x

Keywords

Search

Navigation