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Diagnosis of primary aldosteronism in the hypertension specialist centers in Italy: a national survey

Journal of Human Hypertension volume 32, pages 745–751 (2018)Cite this article

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Abstract

Primary aldosteronism (PA) is the most common endocrine cause of resistant hypertension. Individuals with PA are at increased cardiovascular risk, and an appropriate management and treatment would ideally reduce such risk. Screening and diagnosis of PA requires a specific diagnostic test which is considered time- and cost-consuming and, as a result, is underperformed in clinical practice. An online survey reviewing available diagnostic procedures, laboratory testing, and clinical protocols for screening and confirmation of PA diagnosis was conducted among clinical lead of Reference and Excellence centers of the Italian Hypertension Society. A total of 102 questionnaires were sent and 62 centers participated in the survey. Assessment of the plasma renin (plasma renin activity/direct renin concentration) and plasma aldosterone concentration (PAC) was available in all centers. Captopril challenge test (CCT) and saline infusion test (SIT) were available in 60% and 61% of the centers, respectively. Fludrocortisone suppression test was available in 32% of the units. Adrenal vein sampling was accessible in 32% of the centers. We found discrepancies in cutoff levels of aldosterone-to-renin ratio (ARR) and PAC after SIT. Other discrepancies involved the duration of the wash-out period before ARR testing and dosage of captopril administered during CCT. In conclusion, although all centers are sufficiently equipped to perform PA screening, often patients should be referred to other centers to confirm the diagnosis of PA. A greater uniformity across centers to define precise cutoffs for screening and confirmatory testing for the diagnosis of PA would be of utility.

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References

  1. Olsen MH, Angell SY, Asma S, Boutouyrie P, Burger D, Chirinos JA, et al. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension. Lancet. 2016;388:2665–712.

    Article  Google Scholar 

  2. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990–2015. JAMA. 2017;317:165–82.

    Article  Google Scholar 

  3. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008;51:1403–19.

    Article  CAS  Google Scholar 

  4. Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, et al. J Am Coll Cardiol. 2006;48:2293–300.

    Article  CAS  Google Scholar 

  5. Lim PO, Dow E, Brennan G, Jung RT, MacDonald TM. High prevalence of primary aldosteronism in the Tayside hypertension clinic population. J Hum Hypertens. 2000;14:311–5.

    Article  CAS  Google Scholar 

  6. Monticone S, Burrello J, Tizzani D, Bertello C, Viola A, Buffolo F, et al. Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice. J Am Coll Cardiol. 2017;69:1811–20.

    Article  Google Scholar 

  7. Calhoun DA, Nishizaka MK, Zaman MA, Thakkar RB, Weissmann P. Hyperaldosteronism among black and white subjects with resistant hypertension. Hypertension. 2002;40:892–6.

    Article  CAS  Google Scholar 

  8. Rossi GP, Bernini G, Desideri G, Fabris B, Ferri C, Giacchetti G, et al. Renal damage in primary aldosteronism: results of the PAPY Study. Hypertension. 2006;48:232–8.

    Article  CAS  Google Scholar 

  9. Monticone S, D’Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2018;6:41–50.

    Article  CAS  Google Scholar 

  10. Lin YH, Lin LY, Chen A, et al. Adrenalectomy improves increased carotid intima-media thickness and arterial stiffness in patients with aldosterone producing adenoma. Atherosclerosis. 2012;221:154–9.

    Article  CAS  Google Scholar 

  11. Rossi GP, Sacchetto A, Visentin P, Canali C, Graniero GR, Palatini P, et al. Changes in left ventricular anatomy and function in hypertension and primary aldosteronism. Hypertension. 1996;27:1039–45.

    Article  CAS  Google Scholar 

  12. Catena C, Colussi G, Lapenna R, Nadalini E, Chiuch A, Gianfagna P, et al. Long-term cardiac effects of adrenalectomy or mineralocorticoid antagonists in patients with primary aldosteronism. Hypertension. 2007;50:911–8.

    Article  CAS  Google Scholar 

  13. Ohno Y, Sone M, Inagaki N, Yamasaki T, Ogawa O, Takeda Y, et al. Prevalence of cardiovascular disease and its risk factors in primary aldosteronism: a multicenter study in Japan. Hypertension. 2018;71:530–7.

    Article  CAS  Google Scholar 

  14. Savard S, Amar L, Plouin PF, Steichen O. Cardiovascular complications associated with primary aldosteronism: a controlled cross-sectional study. Hypertension. 2013;62:331–6.

    Article  CAS  Google Scholar 

  15. Mulatero P, Monticone S, Bertello C, Viola A, Tizzani D, Iannaccone A, et al. Long-term cardio- and cerebrovascular events in patients with primary aldosteronism. J Clin Endocrinol Metab. 2013;98:4826–33.

    Article  CAS  Google Scholar 

  16. Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol. 2005;45:1243–8.

    Article  CAS  Google Scholar 

  17. Rossi GP, Maiolino G, Flego A, Belfiore A, Bernini G, Fabris B, et al. Adrenalectomy lowers incident atrial fibrillation in primary aldosteronism patients at long term. Hypertension. 2018;71:585–91.

    Article  CAS  Google Scholar 

  18. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, et al. Case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101:1889–916.

    Article  CAS  Google Scholar 

  19. Mulatero P, Monticone S, Burrello J, Veglio F, Williams TA, Funder J. Guidelines for primary aldosteronism: uptake by primary care physicians in Europe. J Hypertens. 2016;34:2253–7.

    Article  CAS  Google Scholar 

  20. Tocci G, De Luca N, Sarzani R, Ambrosioni E, Borghi C, Cottone S, et al. National survey on excellence centers and reference centers for hypertension diagnosis and treatment: geographical distribution, medical facilities and diagnostic opportunities. High Blood Press Cardiovasc Prev. 2014;21:29–36.

    Article  Google Scholar 

  21. Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol. 2018;6:51–59.

    Article  Google Scholar 

  22. Velema MS, Terlouw JM, de Nooijer AH, Nijkamp MD, Jacobs N, Deinum J. Psychological symptoms and well-being after treatment for primary aldosteronism. Horm Metab Res. 2018. https://doi.org/10.1055/a-0628-6847.

    Article  CAS  Google Scholar 

  23. Ahmed AH, Gordon RD, Sukor N, Pimenta E, Stowasser M. Quality of life in patients with bilateral primary aldosteronism before and during treatment with spironolactone and/or amiloride, including a comparison with our previously published results in those with unilateral disease treated surgically. J Clin Endocrinol Metab. 2011;96:2904–11.

    Article  CAS  Google Scholar 

  24. Burrello J, Monticone S, Buffolo F, Lucchiari M, Tetti M, Rabbia F, et al. Diagnostic accuracy of aldosterone and renin measurement by chemiluminescent immunoassay and radioimmunoassay in primary aldosteronism. J Hypertens. 2016;34:920–7.

    Article  CAS  Google Scholar 

  25. Dorrian CA, Toole BJ, Alvarez-Madrazo S, Kelly A, Connell JM, Wallace AM. A screening procedure for primary aldosteronism based on the Diasorin Liaison automated chemiluminescent immunoassay for direct renin. Ann Clin Biochem. 2010;47:195–9.

    Article  CAS  Google Scholar 

  26. Rossi GP, Ceolotto G, Rossitto G, Seccia TM, Maiolino G, Berton C, et al. Prospective validation of an automated chemiluminescence-based assay of renin and aldosterone for the work-up of arterial hypertension. Clin Chem Lab Med. 2016;54:1441–50.

    Article  CAS  Google Scholar 

  27. Manolopoulou J, Fischer E, Dietz A, Diederich S, Holmes D, Junnila R, et al. Clinical validation for the aldosterone-to-renin ratio and aldosterone suppression testing using simultaneous fully automated chemiluminescence immunoassays. J Hypertens. 2015;33:2500–11.

    Article  CAS  Google Scholar 

  28. Fischer E, Beuschlein F, Bidlingmaier M, Reincke M. Commentary on the Endocrine Society Practice Guidelines: consequences of adjustment of antihypertensive medication in screening of primary aldosteronism. Rev Endocr Metab Disord. 2011;12:43–48.

    Article  CAS  Google Scholar 

  29. Stowasser M, Gordon RD. Primary aldosteronism—careful investigation is essential and rewarding. Mol Cell Endocrinol. 2004;217:33–39.

    Article  CAS  Google Scholar 

  30. Song Y, Yang S, He W, Hu J, Cheng Q, Wang Y, et al. Confirmatory Tests for the Diagnosis of Primary Aldosteronism: A Prospective Diagnostic Accuracy Study. Hypertension. 2018;71:118–24.

    Article  CAS  Google Scholar 

  31. Jankowski A, Skorek A, Krzyśko K, Zarzycki PK, Ochocka RJ, Lamparczyk H. Captopril: determination in blood and pharmacokinetics after single oral dose. J Pharm Biomed Anal. 1995;13:655–60.

    Article  CAS  Google Scholar 

  32. Cornu E, Steichen O, Nogueira-Silva L, Küpers E, Pagny JY, Grataloup C, et al. Suppression of aldosterone secretion after recumbent saline infusion does not exclude lateralized primary aldosteronism. Hypertension. 2016;68:989–94.

    Article  CAS  Google Scholar 

  33. Monticone S, Viola A, Rossato D, Veglio F, Reincke M, Gomez-Sanchez C, et al. Adrenal vein sampling in primary aldosteronism: towards a standardised protocol. Lancet Diabetes Endocrinol. 2015;3:296–303.

    Article  CAS  Google Scholar 

  34. Kempers MJ, Lenders JW, van Outheusden L, van der Wilt GJ, Schultze Kool LJ, Hermus AR, et al. Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism. Ann Intern Med. 2009;151:329–37.

    Article  Google Scholar 

  35. Dekkers T, Prejbisz A, Kool LJS, Groenewoud HJMM, Velema M, Spiering W, et al. Adrenal vein sampling versus CT scan to determine treatment in primary aldosteronism: an outcome-based randomised diagnostic trial. Lancet Diabetes Endocrinol. 2016;4:739–46.

    Article  Google Scholar 

  36. Beuschlein F, Mulatero P, Asbach E, Monticone S, Catena C, Sechi LA, et al. The SPARTACUS trial: controversies and unresolved issues. Horm Metab Res. 2017;49:936–42.

    Article  CAS  Google Scholar 

  37. Buffolo F, Monticone S, Williams TA, Rossato D, Burrello J, Tetti M, et al. Subtype diagnosis of primary aldosteronism: is adrenal vein sampling always necessary? Int J Mol Sci. 2017;18:pii: E848.

    Article  Google Scholar 

  38. Rossi GP, Barisa M, Allolio B, Auchus RJ, Amar L, Cohen D, et al. The Adrenal Vein Sampling International Study (AVIS) for identifying the major subtypes of primary aldosteronism. J Clin Endocrinol Metab. 2012;97:1606–14.

    Article  CAS  Google Scholar 

  39. Monticone S, Satoh F, Dietz AS, Goupil R, Lang K, Pizzolo F, et al. Clinical management and outcomes of adrenal hemorrhage following adrenal vein sampling in primary aldosteronism. Hypertension. 2016;67:146–52.

    Article  CAS  Google Scholar 

  40. Mulatero P, Tizzani D, Viola A, et al. Prevalence and characteristics of familial hyperaldosteronism: the PATOGEN study (Primary Aldosteronism in TOrino-GENetic forms). Hypertension. 2011;58:797–803.

    Article  CAS  Google Scholar 

  41. So A, Duffy DL, Gordon RD, et al. Familial hyperaldosteronism type II is linked to the chromosome 7p22 region but also shows predicted heterogeneity. J Hypertens. 2005;23:1477–84.

    Article  CAS  Google Scholar 

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Author notes

  1. These authors contributed equally: Giacomo Pucci, Silvia Monticone

Authors and Affiliations

  1. Department of Medicine, University of Perugia, Perugia, Italy

    Giacomo Pucci

  2. Unit of Internal Medicine, Terni University Hospital, Terni, Italy

    Giacomo Pucci

  3. Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy

    Silvia Monticone

  4. Internal Medicine-ASST Brescia & University of Brescia, Brescia, Italy

    Claudia Agabiti Rosei & Fabio Bertacchini

  5. Department of General Medicine, San Bortolo Hospital, Vicenza, Italy

    Giulia Balbi & Fabio Ragazzo

  6. U.O. Cardiologia, Ospedale Cittadella, Cittadella, Italy

    Francesca Saladini

  7. Sleep Disorder Centre, Department of Cardiovascular, Neural and Metabolic Sciences IRCCS Istituto Auxologico Italiano, Milan, Italy

    Martino F. Pengo

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  1. Giacomo Pucci
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on behalf of the Young Investigator Group of the Italian Hypertension Society (Società Italiana dell’Ipertensione Arteriosa)

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Correspondence to Giacomo Pucci.

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Pucci, G., Monticone, S., Agabiti Rosei, C. et al. Diagnosis of primary aldosteronism in the hypertension specialist centers in Italy: a national survey. J Hum Hypertens 32, 745–751 (2018). https://doi.org/10.1038/s41371-018-0094-6

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  • DOI: https://doi.org/10.1038/s41371-018-0094-6

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