This Article Full Text Full Text (PDF) All Versions of this Article: 50/3/447    most recent HYPERTENSIONAHA.106.086116v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Calhoun, D. A. Articles by Kaplan, N. M. Search for Related Content PubMed PubMed Citation Articles by Calhoun, D. A. Articles by Kaplan, N. M. Related Collections Other hypertension Clinical Studies

(Hypertension. 2007;50:447.)
© 2007 American Heart Association, Inc.

Controversies in Hypertension

Is There an Unrecognized Epidemic of Primary Aldosteronism? (Pro)

From the Vascular Biology and Hypertension Program, University of Alabama at Birmingham.

Correspondence to David A. Calhoun, 430 BMR 2, 1530 3rd Ave South, Birmingham, AL 35294-2180. E-mail dcalhoun@uab.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
As evidenced by this debate, controversy persists as to the true prevalence of primary aldosteronism (PA) and, perhaps more importantly, concerns regarding the clinical rationale of evaluating large numbers of hypertensive patients for evidence of aldosterone excess. In regard to the former controversy, it has been suggested that reports of a high prevalence of PA exaggerate the true value for a variety of methodologic shortcomings, including overreliance on the plasma aldosterone/plasma renin ratio (ARR) to estimate the prevalence of PA; a selection bias from estimating the general prevalence of PA based on patients referred to hypertension specialty clinics; and because of inappropriately considering idiopathic hyperaldosteronism (presumed secondary to adrenal hyperplasia) to be a type of PA.^1–3 Suggestions to broadly screen hypertensive patients for PA have led to the latter controversy as to whether the costs and risks of potentially evaluating large numbers of hypertensive patients for the presence of PA are clinically justified.¹ The controversies are obviously related but especially so for clinicians treating hypertension, because they reflect different strategies as to how and when to screen patients for PA.

	Early Estimates of PA Prevalence

 
Early studies indicated that PA was an uncommon cause of hypertension with a prevalence of <1% to 2%.^4–7 However, in these studies, testing for PA was primarily limited to patients presenting with hypokalemia. Consistent with the initial description of the syndrome, hypokalemia was thought to be an obligatory characteristic, such that normal potassium levels were thought to reliably exclude PA. However, as later reported by Conn et al,⁸ hypokalemia is . . . [Full Text of this Article]

Norman M. Kaplan

This article has been cited by other articles:

				E. Born-Frontsberg, M. Reincke, L. C. Rump, S. Hahner, S. Diederich, R. Lorenz, B. Allolio, J. Seufert, C. Schirpenbach, F. Beuschlein, et al. Cardiovascular and Cerebrovascular Comorbidities of Hypokalemic and Normokalemic Primary Aldosteronism: Results of the German Conn's Registry J. Clin. Endocrinol. Metab., April 1, 2009; 94(4): 1125 - 1130. [Abstract] [Full Text] [PDF]

				J. E. Hall Hypertension: Update 2008 Hypertension, September 1, 2008; 52(3): 425 - 428. [Full Text] [PDF]

				B Rayner Primary aldosteronism and aldosterone-associated hypertension J. Clin. Pathol., July 1, 2008; 61(7): 825 - 831. [Abstract] [Full Text] [PDF]

				D. G. Romero, M. W. Plonczynski, C. A. Carvajal, E. P. Gomez-Sanchez, and C. E. Gomez-Sanchez Microribonucleic Acid-21 Increases Aldosterone Secretion and Proliferation in H295R Human Adrenocortical Cells Endocrinology, May 1, 2008; 149(5): 2477 - 2483. [Abstract] [Full Text] [PDF]

				A. W. Krug and M. Ehrhart-Bornstein Aldosterone and Metabolic Syndrome: Is Increased Aldosterone in Metabolic Syndrome Patients an Additional Risk Factor? Hypertension, May 1, 2008; 51(5): 1252 - 1258. [Full Text] [PDF]

				P.-F. Plouin About an Epidemic of Primary Aldosteronism Hypertension, February 1, 2008; 51(2): e6 - e6. [Full Text] [PDF]

				J. H. Pratt A Not-So-Modest Proposal That a "Modest" Increase in Aldosterone Causes Hypertension and More Hypertension, January 1, 2008; 51(1): 39 - 40. [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]