Hypertension. 2002;40:892-896
Published online before print October 21, 2002, doi: 10.1161/01.HYP.0000040261.30455.B6
Published online before print October 21, 2002, doi: 10.1161/01.HYP.0000040261.30455.B6
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Hypertension. 2002;40:892.)
© 2002 American Heart Association, Inc.
Scientific Contributions |
Hyperaldosteronism Among Black and White Subjects With Resistant Hypertension
From the Vascular Biology and Hypertension Program, University of Alabama at Birmingham (M.K.N., M.A.Z.), and the Veterans Affairs Medical Center (D.A.C.), Birmingham, Ala; St. Joseph Mercy Hospital (R.B.T.), Ypsilanti, Mich; and the Hypertension Department, Favaloro Foundation (P.W.), Buenos Aires, Argentina.
Correspondence to David A. Calhoun, MD, 520 ZRB, 703 South 19th Street, Birmingham, AL 35294-007. E-mail dcalhoun{at}uab.edu
Recent reports suggesting that the prevalence of primary hyperaldosteronism may be higher than historically thought have relied on an elevated plasma aldosterone concentration/plasma renin activity ratio to either diagnose or identify subjects at high risk of having primary hyperaldosteronism and have not included suppression testing of all evaluated subjects. In this prospective study of 88 consecutive patients referred to a university clinic for resistant hypertension, we determined the 24-hour urinary aldosterone excretion during high dietary salt ingestion, baseline plasma renin activity, and plasma aldosterone in all subjects. Primary hyperaldosteronism was confirmed if plasma renin activity was <1.0 ng/mL per hour and urinary aldosterone was >12 µg/24-hour during high urinary sodium excretion (>200 mEq/24-hour). Eighteen subjects (20%) were confirmed to have primary hyperaldosteronism. The prevalence of hyperaldosteronism was similar in black and white subjects. Of the 14 subjects with confirmed hyperaldosteronism who have been treated with spironolactone, all have manifested a significant reduction in blood pressure. In this population, an elevated plasma aldosterone/plasma renin activity ratio (>20) had a sensitivity of 89% and a specificity of 71% with a corresponding positive predictive value of 44% and a negative predictive value of 96%. These data provide strong evidence that hyperaldosteronism is a common cause of resistant hypertension in black and white subjects. The accuracy of these results is strengthened by having done suppression testing of all evaluated subjects.
Key Words: hyperaldosteronism • hypertension, essential • blacks • diuretics • renin
This article has been cited by other articles:
 |
|
 |
|
  E. Pimenta, K. K. Gaddam, S. Oparil, I. Aban, S. Husain, L. J. Dell'Italia, and D. A. Calhoun Effects of Dietary Sodium Reduction on Blood Pressure in Subjects With Resistant Hypertension: Results From a Randomized Trial Hypertension, September 1, 2009; 54(3): 475 - 481. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Pitt RAAS inhibition/blockade in patients with cardiovascular disease: implications of recent large-scale randomised trials for clinical practice Heart, August 1, 2009; 95(15): 1205 - 1208. [Full Text] [PDF]
|
|
|
|
 |
|
 N. Sukor, R. D. Gordon, Y. K. Ku, M. Jones, and M. Stowasser Role of Unilateral Adrenalectomy in Bilateral Primary Aldosteronism: A 22-Year Single Center Experience J. Clin. Endocrinol. Metab., July 1, 2009; 94(7): 2437 - 2445. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Sowers, A. Whaley-Connell, and M. Epstein Narrative Review: The Emerging Clinical Implications of the Role of Aldosterone in the Metabolic Syndrome and Resistant Hypertension Ann Intern Med, June 2, 2009; 150(11): 776 - 783. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. Sanders Dietary Salt Intake, Salt Sensitivity, and Cardiovascular Health Hypertension, March 1, 2009; 53(3): 442 - 445. [Full Text] [PDF]
|
|
|
|
 |
|
 R. D. Vorona Sleep, Sleep Disorders, and the Endocrine System ACCP Sleep Med Brd Rev, January 1, 2009; 4(0): 163 - 184. [Full Text] [PDF]
|
|
|
|
|
|
B. C. Rossier and L. Schild Epithelial Sodium Channel: Mendelian Versus Essential Hypertension Hypertension, October 1, 2008; 52(4): 595 - 600. [Full Text] [PDF]
|
|
|
|
|
|
J. W. Funder, R. M. Carey, C. Fardella, C. E. Gomez-Sanchez, F. Mantero, M. Stowasser, W. F. Young Jr., and V. M. Montori Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., September 1, 2008; 93(9): 3266 - 3281. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Calhoun, D. Jones, S. Textor, D. C. Goff, T. P. Murphy, R. D. Toto, A. White, W. C. Cushman, W. White, D. Sica, et al. Resistant Hypertension: Diagnosis, Evaluation, and Treatment: A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research Circulation, June 24, 2008; 117(25): e510 - e526. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. K. Gaddam, M. K. Nishizaka, M. N. Pratt-Ubunama, E. Pimenta, I. Aban, S. Oparil, and D. A. Calhoun Characterization of Resistant Hypertension: Association Between Resistant Hypertension, Aldosterone, and Persistent Intravascular Volume Expansion Arch Intern Med, June 9, 2008; 168(11): 1159 - 1164. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Calhoun, D. Jones, S. Textor, D. C. Goff, T. P. Murphy, R. D. Toto, A. White, W. C. Cushman, W. White, D. Sica, et al. Resistant Hypertension: Diagnosis, Evaluation, and Treatment: A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research Hypertension, June 1, 2008; 51(6): 1403 - 1419. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. C. Connell, S. M. MacKenzie, E. M. Freel, R. Fraser, and E. Davies A Lifetime of Aldosterone Excess: Long-Term Consequences of Altered Regulation of Aldosterone Production for Cardiovascular Function Endocr. Rev., April 1, 2008; 29(2): 133 - 154. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. A. Davies, C. Hu, N. A. Guagliardo, N. Sen, X. Chen, E. M. Talley, R. M. Carey, D. A. Bayliss, and P. Q. Barrett TASK channel deletion in mice causes primary hyperaldosteronism PNAS, February 12, 2008; 105(6): 2203 - 2208. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Pimenta, K. K. Gaddam, M. N. Pratt-Ubunama, M. K. Nishizaka, I. Aban, S. Oparil, and D. A. Calhoun Relation of Dietary Salt and Aldosterone to Urinary Protein Excretion in Subjects With Resistant Hypertension Hypertension, February 1, 2008; 51(2): 339 - 344. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. J. Brown Aldosterone and Vascular Inflammation Hypertension, February 1, 2008; 51(2): 161 - 167. [Full Text] [PDF]
|
|
|
|
|
|
R. J. Auchus and M. H. Drazner Will the Lessons From Primary Aldosteronism Change the Treatment of Hypertension and Left Ventricular Hypertrophy? Hypertension, November 1, 2007; 50(5): 837 - 839. [Full Text] [PDF]
|
|
|
|
|
|
M. J Brown Renin: friend or foe? Heart, September 1, 2007; 93(9): 1026 - 1033. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Calhoun and N. M. Kaplan Is There an Unrecognized Epidemic of Primary Aldosteronism? (Pro) Hypertension, September 1, 2007; 50(3): 447 - 453. [Full Text] [PDF]
|
|
|
|
|
|
N. M. Kaplan and D. A. Calhoun Is There an Unrecognized Epidemic of Primary Aldosteronism? (Con) Hypertension, September 1, 2007; 50(3): 454 - 458. [Full Text] [PDF]
|
|
|
|
|
|
G. P. Rossi, A. Belfiore, G. Bernini, G. Desideri, B. Fabris, C. Ferri, G. Giacchetti, C. Letizia, M. Maccario, F. Mallamaci, et al. Comparison of the Captopril and the Saline Infusion Test for Excluding Aldosterone-Producing Adenoma Hypertension, August 1, 2007; 50(2): 424 - 431. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Hood, K. P. Taylor, M. J. Ashby, and M. J. Brown The Spironolactone, Amiloride, Losartan, and Thiazide (SALT) Double-Blind Crossover Trial in Patients With Low-Renin Hypertension and Elevated Aldosterone-Renin Ratio Circulation, July 17, 2007; 116(3): 268 - 275. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Auchus, D. W. Chandler, S. Singeetham, N. Chokshi, F. E. Nwariaku, B. L. Dolmatch, S. A. Holt, F. H. Wians Jr., S. C. Josephs, C. K. Trimmer, et al. Measurement of 18-Hydroxycorticosterone during Adrenal Vein Sampling for Primary Aldosteronism J. Clin. Endocrinol. Metab., July 1, 2007; 92(7): 2648 - 2651. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. E. Umpierrez, P. Cantey, D. Smiley, A. Palacio, D. Temponi, K. Luster, and A. Chapman Primary Aldosteronism in Diabetic Subjects With Resistant Hypertension Diabetes Care, July 1, 2007; 30(7): 1699 - 1703. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Chapman, J. Dobson, S. Wilson, B. Dahlof, P. S. Sever, H. Wedel, N. R. Poulter, and on behalf of the Anglo-Scandinavian Cardiac Outcom Effect of Spironolactone on Blood Pressure in Subjects With Resistant Hypertension Hypertension, April 1, 2007; 49(4): 839 - 845. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. N. Pratt-Ubunama, M. K. Nishizaka, R. L. Boedefeld, S. S. Cofield, S. M. Harding, and D. A. Calhoun Plasma Aldosterone Is Related to Severity of Obstructive Sleep Apnea in Subjects With Resistant Hypertension Chest, February 1, 2007; 131(2): 453 - 459. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Calhoun Aldosterone and Cardiovascular Disease: Smoke and Fire Circulation, December 12, 2006; 114(24): 2572 - 2574. [Full Text] [PDF]
|
|
|
|
 |
|
 G. P. Rossi, G. Bernini, C. Caliumi, G. Desideri, B. Fabris, C. Ferri, C. Ganzaroli, G. Giacchetti, C. Letizia, M. Maccario, et al. A Prospective Study of the Prevalence of Primary Aldosteronism in 1,125 Hypertensive Patients J. Am. Coll. Cardiol., December 5, 2006; 48(11): 2293 - 2300. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Stowasser and R. D. Gordon Aldosterone Assays: An Urgent Need for Improvement Clin. Chem., September 1, 2006; 52(9): 1640 - 1642. [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Calhoun Aldosteronism and Hypertension Clin. J. Am. Soc. Nephrol., September 1, 2006; 1(5): 1039 - 1045. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Mulatero, A. Milan, F. Fallo, G. Regolisti, F. Pizzolo, C. Fardella, L. Mosso, L. Marafetti, F. Veglio, and M. Maccario Comparison of Confirmatory Tests for the Diagnosis of Primary Aldosteronism J. Clin. Endocrinol. Metab., July 1, 2006; 91(7): 2618 - 2623. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Fallo, F. Veglio, C. Bertello, N. Sonino, P. Della Mea, M. Ermani, F. Rabbia, G. Federspil, and P. Mulatero Prevalence and Characteristics of the Metabolic Syndrome in Primary Aldosteronism J. Clin. Endocrinol. Metab., February 1, 2006; 91(2): 454 - 459. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Daunt Adrenal Vein Sampling: How to Make It Quick, Easy, and Successful RadioGraphics, October 1, 2005; 25(suppl_1): S143 - S158. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. R. Krakoff Diuretics for Hypertension Circulation, September 6, 2005; 112(10): e127 - e129. [Full Text] [PDF]
|
|
|
|
|
|
C. Saha, G. J. Eckert, W. T. Ambrosius, T.-Y. Chun, M. A. Wagner, Q. Zhao, and J. H. Pratt Improvement in Blood Pressure With Inhibition of the Epithelial Sodium Channel in Blacks With Hypertension Hypertension, September 1, 2005; 46(3): 481 - 487. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Olivieri, A. Ciacciarelli, D. Signorelli, F. Pizzolo, P. Guarini, C. Pavan, A. Corgnati, S. Falcone, R. Corrocher, A. Micchi, et al. Aldosterone to Renin Ratio in a Primary Care Setting: The Bussolengo Study J. Clin. Endocrinol. Metab., September 1, 2004; 89(9): 4221 - 4226. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. H. Perschel, R. Schemer, L. Seiler, M. Reincke, J. Deinum, C. Maser-Gluth, D. Mechelhoff, R. Tauber, and S. Diederich Rapid Screening Test for Primary Hyperaldosteronism: Ratio of Plasma Aldosterone to Renin Concentration Determined by Fully Automated Chemiluminescence Immunoassays Clin. Chem., September 1, 2004; 50(9): 1650 - 1655. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. K. Nishizaka, M. A. Zaman, S. A. Green, K. Y. Renfroe, and D. A. Calhoun Impaired Endothelium-Dependent Flow-Mediated Vasodilation in Hypertensive Subjects With Hyperaldosteronism Circulation, June 15, 2004; 109(23): 2857 - 2861. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. L. Goodfriend and D. A. Calhoun Resistant Hypertension, Obesity, Sleep Apnea, and Aldosterone: Theory and Therapy Hypertension, March 1, 2004; 43(3): 518 - 524. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Calhoun, M. K. Nishizaka, M. A. Zaman, and S. M. Harding Aldosterone Excretion Among Subjects With Resistant Hypertension and Symptoms of Sleep Apnea Chest, January 1, 2004; 125(1): 112 - 117. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Oparil, M. A. Zaman, and D. A. Calhoun Pathogenesis of Hypertension Ann Intern Med, November 4, 2003; 139(9): 761 - 776. [Full Text] [PDF]
|
|
|
|
|
|
L. Mosso, C. Carvajal, A. Gonzalez, A. Barraza, F. Avila, J. Montero, A. Huete, A. Gederlini, and C. E. Fardella Primary Aldosteronism and Hypertensive Disease Hypertension, August 1, 2003; 42(2): 161 - 165. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Baxter, W. F. Young Jr., and P. Webb Cardiovascular Endocrinology: Introduction Endocr. Rev., June 1, 2003; 24(3): 253 - 260. [Full Text] [PDF]
|
|
|
|
 |
|
 W. F. Young Jr. Minireview: Primary Aldosteronism--Changing Concepts in Diagnosis and Treatment Endocrinology, June 1, 2003; 144(6): 2208 - 2213. [Abstract] [Full Text] [PDF]
|
|