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| |  CHBPR: Primary Hyperaldosteronism More Common Than Previously Thought By W. A. Thomasson Special to DG News CHICAGO, IL -- September 26, 2001 - Researchers found a 10 percent incidence of primary hyperaldosteronism among a large, unselected group of primary care hypertension patients. Their data was presented yesterday (September 25) at the annual meeting of the Council for High Blood Pressure Research, in Chicago, Illinois. The study, reported by Morris Brown, MD, and Sue Hood, RN, both of Cambridge University in Cambridge, England, along with colleagues at other British institutions, defined hyperaldosteronism as an aldosterone/renin ratio greater than 800 and response to a therapeutic trial of spironolactone. Dr. Brown noted, however, that there is a continuous distribution of aldosterone-renin ratios, and among those with ratios above 400, there is only a moderate correlation with spironolactone response. These results may in part represent variations in aldosterone sensitivity, since very high serum aldosterone levels appear to be rare, and computed tomography (CT) scans identified only five adrenal adenomas large enough to suggest surgery. In the study, primary care physicians measured serum electrolytes in 849 patients diagnosed with hypertension and measured serum aldosterone/renin ratio in 529 of these patients. Patients with ratios above 800 constituted 12.3 percent of the total, with the proportion being higher (17 percent) among those being treated with beta-blockers and, of course, lower among those treated with ACE inhibitors. Seventy percent of those with aldosterone/renin ratios greater than 800 responded to treatment with 50 mg/day of spironolactone with a fall in blood pressure of at least 20 mm Hg, giving an 9.2 percent overall prevalence of hyperaldosteronism in this unselected patient group. The study also found that there was no correlation between presence of primary hyperaldosteronism, as defined, and serum electrolytes. In fact, the best predictor of which patients were likely to exhibit the condition was poor response to previous therapy. Following Dr. Brown’s presentation, there was considerable discussion of the definition of primary hyperaldosteronism employed. The clinical bottom line, however, seems to be that there is a sizable pool of patients who would benefit from spironolactone treatment.
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