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(Hypertension. 2008;51:e3.)
© 2008 American Heart Association, Inc.

Letters to the Editor

Response to More Fuel to the Debate on the "Epidemic of Primary Aldosteronism"

University of Texas Southwestern Medical School, Dallas, Tex

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

The data from the Primary Aldosteronism Prevalence in Italy Study, despite some problems, remain the largest experience for ascertaining the prevalence of primary hypertension.¹ I will answer the claims by Rossi et al² that I made "several inaccurate statements" in regard to these data.

First, the makeup of the population studied is not delineated in the original article. Even if none had resistant hypertension, the patients were almost certainly, at least in part, preselected by their primary physicians for referral to the study centers.

Second, the remarkable correlation between the 2 ARRs seen in primary aldosteronism prevalence in Italy is certainly the exception. I refer again to the cautions proposed by numerous investigators on the variability of responses.^3,4

Third, the comparison by Rossi et al² of the captopril and saline suppression test⁵ was published after my article was submitted. Despite their conclusion, errors with the captopril test continue to surface.⁶

Fourth, because only 43 of the 124 patients with PA had adrenal venous sampling, it is obvious that this "gold standard" was not used to differentiate aldosterone-producing adenoma from bilateral hyperplasia in the majority of patients. Mineralocorticoid scintigraphy, to my knowledge, has not been shown to be definitive, and all of the experts recognize the inaccuracies of computed tomography and MRI.

Fifth, PA is a "big deal" because it is a curable form of hypertension. However, the long-term follow-up of patients with PA who had surgery has clearly shown that they had no better outcome than those given medical therapy.⁷ . . . [Full Text of this Article]