Prevalence of hyperaldosteronism in primary care patients with resistant hypertension

J Am Board Fam Med. 2012 Jan-Feb;25(1):98-103. doi: 10.3122/jabfm.2012.01.110099.


Introduction: Because hyperaldosteronism is the most common curable reason for secondary hypertension, screening is recommended. However, prevalence among general practice patients and feasibility of screening is still unclear. A design to assess prevalence in general practice and barriers against screening was created.

Methods: This was an open, observational pilot study and focus group. In 2 general practices, all patients with arterial hypertension were included. Those with resistant hypertension (>140/90 mm Hg and taking ≥3 antihypertensive drugs) were eligible for screening. The design and feasibility of the study were discussed in a focus group of experienced general practitioners.

Results: Of 3107 patients visiting the practices, 564 were diagnosed as having arterial hypertension. Seventy-nine fulfilled criteria for resistant hypertension. Aldosterone:renin ratio (ARR) could be measured in 63 of those patients. Withdrawal of ß-blocker was feasible in 34 of the 63 with measurable ARR. ARR was positive in 15, and in 3 of those 15 with positive ARR, it was caused by elevated aldosterone levels. Focus group discussion revealed barriers and concerns regarding organizational, financial, and practical aspects of a systematic screening.

Conclusions: Screening for hyperaldosteronism in general practice seems possible in selected patients, but not in a systematic way. Barriers against systematic screening were a necessity for β-blocker cessation as well as structural prerequisites for patient identification.

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage
  • Aged
  • Aldosterone / blood
  • Antihypertensive Agents / therapeutic use*
  • Drug Resistance / physiology*
  • Feasibility Studies
  • Female
  • Germany / epidemiology
  • Humans
  • Hyperaldosteronism / blood
  • Hyperaldosteronism / complications
  • Hyperaldosteronism / diagnosis*
  • Hyperaldosteronism / epidemiology
  • Hypertension / drug therapy*
  • Hypertension / etiology
  • Male
  • Middle Aged
  • Pilot Projects
  • Primary Health Care*
  • Renin / blood


  • Adrenergic beta-Antagonists
  • Antihypertensive Agents
  • Aldosterone
  • Renin