Primary Aldosteronism or Not Primary Aldosteronism
Is This Now the Question in Normotension?
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See related article, pp 950–956
Primary aldosteronism (PA) within hypertensive populations is no longer regarded as being a rare phenomenon. Although some debate around its overall frequency remains, one of the most robust studies in recent years describes a prevalence of ≈10% in unselected hypertensives1; this may rise to ≤20% in subjects with resistant hypertension.2
In 2003, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure introduced a new hypertension category defined as prehypertension to describe individuals with systolic blood pressure ranging from 120 to 139 mm Hg and diastolic blood pressure from 80 to 89 mm Hg.3 Thus, in parallel with this change in perception of blood pressure classification and recognition that hypertension is not an arbitrary definition, so have there been attempts to demonstrate disordered aldosterone regulation within normotensive or prehypertensive cohorts.
The concept of altered aldosterone dynamics predisposing to hypertension over time was first demonstrated in the Framingham Offspring study in which serum aldosterone was measured in a cohort of 1688 normotensive participants.4 During a 4-year follow-up period, when compared with the lowest quartile of serum aldosterone, the highest quartile was associated with an 1.6-fold increased risk of elevated blood pressure (95% confidence interval, 1.19–2.14) and a similar risk of overt hypertension (95% confidence interval, 1.05–2.46).
Therefore, although there is evidence that increased aldosterone levels (still within the physiological range) can predispose …