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(Hypertension. 2008;51:e1.)
© 2008 American Heart Association, Inc.

Letters to the Editor

More Fuel to the Debate on the "Epidemics of Primary Aldosteronism"

Gian Paolo Rossi; Achille C. Pessina; Franco Mantero for the Primary Aldosteronism Prevalence in Italy Study Investigators (see Appendix)

Department of Clinical and Experimental Medicine, Internal Medicine 4, University Hospital, Padova, Italy

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

	Introduction

 
To the Editor:

To re-emphasize his views on primary aldosteronism (PA), Kaplan stated that the Primary Aldosteronism Prevalence in Italy Study¹ "has...problems that question the reported prevalence of PA of 11.2%"; however, in exemplifying them, he collected several inaccurate statements.²

He contended that referral of patients with more severe resistant hypertension might have led to overestimating the PA prevalence, but no patient had resistant hypertension and only a minority had grade 3 hypertension; moreover, exclusion of the 2 centers with the highest prevalence did not markedly lower the prevalence rate of PA.¹

Second, Kaplan² questioned the aldosterone/renin ratio (ARR) performance and criticized that only 1 ARR was performed, evidently ignoring that the ARR was done at screening in all of the patients¹ and once again after, on average, 4 weeks in the 317 patients who had the saline infusion test.³ Although performed under different conditions, the 2 ARRs showed a strong significant (P<0.0001) correlation; moreover, Bland-Altman plot, Passing-Bablok regression, and concordance correlation coefficient excluded any significant between-test variability. Importantly, no aldosterone-producing adenoma (APA) patient pinpointed with the first ARR was missed with the second, and vice versa. Thus, the claimed poor reproducibility of the ARR is not supported by the data. Moreover, although performing an ARR is no more expensive than a lipid profile, its result can have a greater impact on lifetime cardiovascular risk of those hypertensive subjects who have a long-term curable APA.

Third, despite quoting a head-to-head comparison of the captopril and the saline infusion . . . [Full Text of this Article]

This article has been cited by other articles:

				N. M. Kaplan Response to More Fuel to the Debate on the "Epidemic of Primary Aldosteronism" Hypertension, January 1, 2008; 51(1): e3 - e3. [Full Text] [PDF]