Screening for Primary Aldosteronism in a Cohort of Brazilian Patients With Resistant Hypertension

Authors

  • Armando R. Nogueira MD, PhD,

    1. From the Hypertension Program, University Hospital Clementino Fraga Filho,1 and the Medical School and Institute of Community Health,2 Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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  • and 1 Katia V. Bloch MD, PhD 2

    1. From the Hypertension Program, University Hospital Clementino Fraga Filho,1 and the Medical School and Institute of Community Health,2 Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Armando R. Nogueira, MD, PhD, Rua Visconde Silva 52/602, Rio de Janeiro, Brazil 22271-090
E-mail: armando@hucff.ufrj.br

Abstract

The objective was to estimate the prevalence of plasma aldosterone concentration:plasma renin activity ratio >30 ng/dL:ng/mL/h in patients with resistant hypertension and to describe the computed tomography findings of adrenal glands in those with elevated ratios. In a cross-sectional design, 492 patients were enrolled. All patients with plasma aldosterone concentration:plasma renin activity ratio ≥30 ng/dL:ng/mL/h (n=77) underwent abdominal computed tomography. Patients with an adrenal image of possible aldosterone-producing adenoma underwent a saline-loading test. The prevalence of elevated plasma aldosterone concentration:plasma renin activity ratio was 15.7% (95% confidence interval, 12.6–19.2). Twelve patients showed adrenal abnormalities on computed tomography. The level of renin was low in 50% of the sample. Results indicate a low prevalence of aldosterone-producing adenoma. Our evidence points out the importance of confirming the hypothesis that essential hypertension, low-renin hypertension, and idiopathic hyperaldosteronism could be the same disease, but at different neurohormonal stages, and aldosterone-producing adenoma may be yet another disease.

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