Screening for primary aldosteronism in 1,181 Swedish primary care patients with hypertension
ObjectivePrimary aldosteronism (PA) is a common cause of hypertension. It entails elevated morbidity and mortality that do not sufficiently improve with conventional antihypertensive therapy. Screening for PA by plasma aldosterone–renin ratio (ARR) enables discovery and specific treatment of affecte...
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Frontiers Media S.A.
2025-04-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2025.1555572/full |
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| author | Nikita Makhnov Nikita Makhnov Nikita Makhnov Jakob Skov Jakob Skov Tobias Åkerström Tobias Åkerström Fredrik Axling Daniel Andernord Mikael Bergenheim Mikael Bergenheim Mauritz Waldén Per Hellman Per Hellman |
| author_facet | Nikita Makhnov Nikita Makhnov Nikita Makhnov Jakob Skov Jakob Skov Tobias Åkerström Tobias Åkerström Fredrik Axling Daniel Andernord Mikael Bergenheim Mikael Bergenheim Mauritz Waldén Per Hellman Per Hellman |
| author_sort | Nikita Makhnov |
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| description | ObjectivePrimary aldosteronism (PA) is a common cause of hypertension. It entails elevated morbidity and mortality that do not sufficiently improve with conventional antihypertensive therapy. Screening for PA by plasma aldosterone–renin ratio (ARR) enables discovery and specific treatment of affected patients. By screening primary care patients with hypertension and evaluating them further according to the Endocrine Society guidelines, we aimed to assess the prevalence of PA, the factors affecting biochemical diagnostics, and the outcome of lateralization studies and of specific treatment of the discovered PA cases.Design, patients, and methodsProspective evaluation of screening for PA was conducted in 1,181 patients. Screening by ARR was performed under current therapy, but without mineralocorticoid receptor antagonists (MRA), under normokalemia, and confirmed by the intravenous saline suppression test, SST#1. Those with results in a defined gray zone underwent therapy adjustment and then completed SST#2. Plasma aldosterone and ARR were compared under different stages of the diagnostic process. All patients with PA were offered adrenal venous sampling, or, in certain cases, adrenocortical-specific positron emission tomography. Lateralizing cases were offered laparoscopic adrenalectomy. Patients with bilateral disease were treated with MRA. Treatment results were assessed after a minimum of 6 months.ResultsA total of 53 discovered cases of (mostly mild) PA corresponded to its prevalence of 4.5%. Initial seated ARR was higher than recumbent ARR before SST#1. At SST#2, initial ARR and final aldosterone were higher than at SST#1. Localizing studies (accepted by 45 patients) found 14 lateralized cases. Of the 11 operated cases, 4 had aldosterone-producing adenoma, and the remainder had micro- and macronodular histopathology. A total of 31 patients had bilateral PA. Both surgical and conservative treatments were well tolerated and led to improved blood pressure and higher renin, indicating risk amelioration.ConclusionsPA is prevalent among primary care patients with hypertension and can be screened for under current antihypertensive therapy. Aldosterone-producing adenoma was rare in this cohort. The study results support active screening of primary care patients with hypertension for PA in order to offer appropriate treatment options. |
| format | Article |
| id | doaj-art-5afbbf25d6ad4ebe9b7abe4f9a8dbfe2 |
| institution | OA Journals |
| issn | 1664-2392 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Endocrinology |
| spelling | doaj-art-5afbbf25d6ad4ebe9b7abe4f9a8dbfe22025-08-20T02:11:54ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922025-04-011610.3389/fendo.2025.15555721555572Screening for primary aldosteronism in 1,181 Swedish primary care patients with hypertensionNikita Makhnov0Nikita Makhnov1Nikita Makhnov2Jakob Skov3Jakob Skov4Tobias Åkerström5Tobias Åkerström6Fredrik Axling7Daniel Andernord8Mikael Bergenheim9Mikael Bergenheim10Mauritz Waldén11Per Hellman12Per Hellman13Department of Surgical Sciences, Uppsala University, Uppsala, SwedenDepartment of Surgery, Karlstad Central Hospital, Karlstad, SwedenCenter for Clinical Research and Education, Karlstad, SwedenDepartment of Medicine, Karlstad Central Hospital, Karlstad, SwedenDepartment of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, SwedenDepartment of Surgical Sciences, Uppsala University, Uppsala, SwedenDepartment of Surgery, Uppsala University Hospital, Uppsala, SwedenDepartment of Surgical Sciences, Uppsala University, Uppsala, SwedenCenter for Clinical Research and Education, Karlstad, SwedenDepartment of Surgery, Karlstad Central Hospital, Karlstad, SwedenDepartment of Health Sciences, Karlstad University, Karlstad, SwedenDepartment of Surgery, Karlstad Central Hospital, Karlstad, SwedenDepartment of Surgical Sciences, Uppsala University, Uppsala, SwedenDepartment of Surgery, Uppsala University Hospital, Uppsala, SwedenObjectivePrimary aldosteronism (PA) is a common cause of hypertension. It entails elevated morbidity and mortality that do not sufficiently improve with conventional antihypertensive therapy. Screening for PA by plasma aldosterone–renin ratio (ARR) enables discovery and specific treatment of affected patients. By screening primary care patients with hypertension and evaluating them further according to the Endocrine Society guidelines, we aimed to assess the prevalence of PA, the factors affecting biochemical diagnostics, and the outcome of lateralization studies and of specific treatment of the discovered PA cases.Design, patients, and methodsProspective evaluation of screening for PA was conducted in 1,181 patients. Screening by ARR was performed under current therapy, but without mineralocorticoid receptor antagonists (MRA), under normokalemia, and confirmed by the intravenous saline suppression test, SST#1. Those with results in a defined gray zone underwent therapy adjustment and then completed SST#2. Plasma aldosterone and ARR were compared under different stages of the diagnostic process. All patients with PA were offered adrenal venous sampling, or, in certain cases, adrenocortical-specific positron emission tomography. Lateralizing cases were offered laparoscopic adrenalectomy. Patients with bilateral disease were treated with MRA. Treatment results were assessed after a minimum of 6 months.ResultsA total of 53 discovered cases of (mostly mild) PA corresponded to its prevalence of 4.5%. Initial seated ARR was higher than recumbent ARR before SST#1. At SST#2, initial ARR and final aldosterone were higher than at SST#1. Localizing studies (accepted by 45 patients) found 14 lateralized cases. Of the 11 operated cases, 4 had aldosterone-producing adenoma, and the remainder had micro- and macronodular histopathology. A total of 31 patients had bilateral PA. Both surgical and conservative treatments were well tolerated and led to improved blood pressure and higher renin, indicating risk amelioration.ConclusionsPA is prevalent among primary care patients with hypertension and can be screened for under current antihypertensive therapy. Aldosterone-producing adenoma was rare in this cohort. The study results support active screening of primary care patients with hypertension for PA in order to offer appropriate treatment options.https://www.frontiersin.org/articles/10.3389/fendo.2025.1555572/fullprimary aldosteronismscreeninghypertensionoutpatientsaldosteronerenin |
| spellingShingle | Nikita Makhnov Nikita Makhnov Nikita Makhnov Jakob Skov Jakob Skov Tobias Åkerström Tobias Åkerström Fredrik Axling Daniel Andernord Mikael Bergenheim Mikael Bergenheim Mauritz Waldén Per Hellman Per Hellman Screening for primary aldosteronism in 1,181 Swedish primary care patients with hypertension Frontiers in Endocrinology primary aldosteronism screening hypertension outpatients aldosterone renin |
| title | Screening for primary aldosteronism in 1,181 Swedish primary care patients with hypertension |
| title_full | Screening for primary aldosteronism in 1,181 Swedish primary care patients with hypertension |
| title_fullStr | Screening for primary aldosteronism in 1,181 Swedish primary care patients with hypertension |
| title_full_unstemmed | Screening for primary aldosteronism in 1,181 Swedish primary care patients with hypertension |
| title_short | Screening for primary aldosteronism in 1,181 Swedish primary care patients with hypertension |
| title_sort | screening for primary aldosteronism in 1 181 swedish primary care patients with hypertension |
| topic | primary aldosteronism screening hypertension outpatients aldosterone renin |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2025.1555572/full |
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