THE PREVALЕNCE OF PRIMARY ALDOSTERONISM IN PATIENTS WITH UNCONTROLLED HYPERTENSION AND IN PATIENTS WITH PREVIOUSLY DETECTED ADRENAL INCIDENTALOMA: THE DATABASE OF ANTIHYPERTENSIVE SPECIALIZED CENTER

Objective. To determine the prevalence of primary aldosteronism (PA) through routine practice — among patients visiting a specialized antihypertensive center due to uncontrolled hypertension or with adrenal incidentalomas.

Design and methods. We included 314 patents with uncontrolled hypertension and 195 patients with incidentalomas. Aldosterone-renin ratio (ARR), hormonal tests and examination for exclusion of symptomatic hypertension were performed in all subjects.

 Results. PA diagnosis was confirmed in 27 patients with uncontrolled hypertension (8,6 % hypertensive patients) and in 17 % patients with adrenal incidentalomas. ARR increase as well as elevated aldosterone level were found in all subjects, and all of them had high PA risk.

Conclusions. The prevalence of PA is 8,6 % patients with uncontrolled hypertension and 17 % patients with adrenal incidentalomas. ARR increase along with aldosterone level elevation should be considered at patient evaluation.

1. Funder J. W., Carey R. M., Fardella C. et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline // J. Clin. Endocrinol. Metab. — 2008. — Vol. 93, № 9. — Р. 3266–3281.

2. Calhoun D.A. Is there an unrecognized epidemic of primary aldosteronism? (Pro) // Hypertension. — 2007. — Vol. 50, № 3. — P. 447–453.

3. Mosso L., Carvajal C., Conzalea A. et al. Primary aldosteronism and hypertensive disease // Hypertension. — 2003. — Vol. 42, № 2. — P. 161–165.

4. Ito Y., Takeda R., Karashima S., Yamamoto Y., Yoneda T., Takeda Y. Prevalence of primary aldosteronism among prehypertensive and stage 1 hypertensive subjects // Hypertens. Res. — 2011. — Vol. 34, № 1. — P. 98–102.

5. Schwartz G., Turner S. Screening for primary aldosteronism in essential hypertension: diagnostic accuracy of the ratio of plasma aldosterone concentration to plasma renin activity // Clin. Chem. — 2005. — Vol. 51, № 2. — P. 386–394.

6. Rossi G., Seccia T., Pessina A. et al. Primary aldosteronism — part I: prevalence, screening, and selection of cases for adrenal vein sampling // J. Nephrol. — 2008. — Vol. 21, № 4. — P. 447–454.

7. Sukor N., Kogovsek C., Gordon R., Robson D., Stowasser M. Improved quality of life, blood pressure, and biochemical status following laparoscopic adrenalectomy for unilateral primary aldosteronism // J. Clin. Endocrinol. Metab. — 2010. — Vol. 95, № 3. — P. 1360–1364.

8. Vasan R.S., Evans J.C., Larson M.G. et al. Serum aldosterone and the incidence of hypertension in nonhypertensive person // N. Eng. J. Med. — 2004. — Vol. 351, № 1. — P. 33–41.

9. Bernini G., Galetta F., Franzoni F. et al. Arterial stiffness, intima-media thickness and carotid artery fibrosis in patients with primary aldosteronism // J. Hypertens. — 2008. — Vol. 26, № 12. — P. 2399–2405.

10. Tsuchiya K., Yoshimoto T., Hirata Y. Endothelial dysfunction is related to aldosterone excess and raised blood pressure // Endocr. J. — 2009. — Vol. 56, № 4. — P. 553–559.

11. Tsioufis C., Tsiachris D., Dimitriadis K. et al. Myocardial and aortic stiffening in the early course of primary aldosteronism // Clin. Cardiol. — 2008. — Vol. 31, № 9. — P. 431–436.

12. Rossi G.P., Bernini G., Desideri G. et al. Renal damage in primary aldosteronism: results of the PAPY study // Hypertension. — 2006. — Vol. 48, № 2. — P. 232–238.

13. Milliez P., Girerd X., Plouin P. et al. Evidence for an increased rate of cardiovascular events in patients with primaryaldosteronism // J. Am. Coll. Cardiol. — 2005. — Vol. 45, № 8. — P. 1243–1248.

14. Stowasser M., Sharman J., Leano R. et al. Evidence for abnormal left ventricular structure and function in normotensive individuals with familial hyperaldosteronism type I // J. Clin. Endocrinol. Metab. — 2005. — Vol. 90, № 9. — P. 5070–5076.

15. Емельянов И.В., Цой У.С., Кравчук Е.Н. и др. Нормализация артериального давления у больной с резистентной артериальной гипертензией после удаления альдостеромы // Ар- после удаления альдостеромы // Артериальная гипертензия. — 2008. — Т. 14, № 3. — С. 285–287. / Emelyanov I.V., Tsoy U.A., Kravchuk E.H. et al. Normalization of blood pressure following surgical removal of aldosteroma // Arterial Hypertension [Arterialnaya Gipertenziya]. — 2008. — Vol. 14, № 3. — P. 285–287 [Russian].

16. Звартау Н.Э., Коростовцева Л.С., Емельянов И.В., Свиряев Ю.В. Первичный альдостеронизм и резистентная арте- Ю.В. Первичный альдостеронизм и резистентная артериальная гипертензия // Артериальная гипертензия. — 2012. — Т. 18, № 6. — С. 514–521. / Zvartau N.E., Korostovtseva L.S., Emelyanov I.V., Sviryaev Yu.V. Primary aldosteronism and resistant arterial hypertension // Arterial Hypertension [Arterialnaya Gipertenziya]. — 2012. — Vol. 18, № 6. — P. 514–521 [Russian].

17. Weidmann P., Steffen F., Beretta-Piccoli C. et al. Correlations between blood pressure, body sodium/blood volume state and plasma renin in patients with terminal kidney insufficiency // Schweiz Med. Wochenschr. — 1975. — Vol. 105, № 51. — P. 1779–1780. [German].

18. Beretta-Piccoli C., Weidmann P., De Châtel R., Reubi F. Hypertension associated with early stage kidney disease. Complementary roles of circulating renin, the body sodium/volume state and duration of hypertension // Am. J. Med. — 1976. — Vol. 61, № 5. — P. 739–747.