Subclinical Primary Aldosteronism and Cardiometabolic Disorders

Extract

The first case of primary aldosteronism (PA), described by Jerome W. Conn in 1954, was a 34-year-old woman with hypertension, muscle weakness related to hypokalemia, tetany related to hyponatremic hypokalemic alkalosis, and a 4-cm adrenal adenoma.¹ During the following years, in which the diagnosis of PA depended on a clinical presentation similar to that of the original case, the disease was considered rare.

But gradually the diagnostic criteria for PA became less restrictive and more specific and reliable. Suppressed plasma renin activity (PRA) provided a clear distinction between PA and secondary aldosteronism, in which PRA was elevated, rather than suppressed.² Guidelines came to advise screening of patients with severe or resistant hypertension, even without hypokalemia or a known adrenal abnormality.³ In the 1980s, the use of the aldosterone/renin ratio (ARR) as a screening test, with nonsuppressibility of aldosterone after salt loading as a confirmatory test, increased the number of cases of PA that were diagnosed. Current estimates suggest that at least 5–10% patients with hypertension, especially resistant hypertension, have PA.³