Primary Aldosteronism: Present and Future.

Primary Aldosteronism: Present and Future. Vitam Horm. 2019;109:285-302 Authors: Funder JW Abstract Primary aldosteronism (PA), currently recognized to be 5-10% of hypertension, has a cardiovascular risk profile double that in age-, sex-, and blood pressure-matched essential hypertensives. Screening for PA is by determining the plasma aldosterone to renin ratio (ARR), followed by one of half a dozen confirmatory/exclusion tests. Unilateral hyperaldosteronism normally reflects an aldosterone producing adenoma; bilateral disease is the more common form, and termed idiopathic hyperaldosteronism (IHA). Subjects confirmed undergo imaging, followed by adrenal venous sampling (AVS) for lateralization. Unilateral lesions undergo laparoscopic adrenalectomy, to normalize aldosterone levels, and in approximately half reduction of BP/antihypertensive use. Bilateral hyperaldosteronism is treated by low dose mineralocorticoid receptor antagonists MRAs, plus amiloride/conventional antihypertensives, if/as indicated.In the future, what is needed is recognition that inappropriate aldosterone levels for sodium status (i.e., PA) represents up to 50% of "essential" hypertensives; all hypertensive should thus be screened by a modified ARR, using 24-h urinary aldosterone rather than a single plasma aldosterone. The current reluctance to do so reflects the costs of AVS if PA is confirmed-optimally by a standard seated saline suppression test-followed by su...
Source: Vitamins and Hormones - Category: Endocrinology Authors: Tags: Vitam Horm Source Type: research