on October 21, 2002
Hypertension. 2002
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
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Submitted on June 7, 2002
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. * To whom correspondence should be addressed. E-mail: dcalhoun{at}uab.edu.
Abstract—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.
\
Revised on July 12, 2002
Hyperaldosteronism Among Black and White
Subjects With Resistant Hypertension
David A. Calhoun*;
Key words: hyperaldosteronism • hypertension, essential • blacks • diuretics • renin
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