Primary Aldosteronism in Patients in China With Recently Detected Hypertension

J Am Coll Cardiol. 2020 Apr 28;75(16):1913-1922. doi: 10.1016/j.jacc.2020.02.052.

Abstract

Background: A total of 44.7% adults in China have hypertension, but the prevalence of primary aldosteronism (PA) in Chinese hypertensive patients is unknown.

Objectives: This study prospectively investigated the prevalence, characteristics, and outcomes of PA in newly diagnosed hypertensive patients.

Methods: In a large community health center, consecutive hypertensive patients with an aldosterone-renin ratio >20 ng/mIU and plasma aldosterone concentration >10 ng/dl underwent captopril challenge test and/or saline infusion test for confirmation of PA. Adrenal computed tomography scan and adrenal vein sampling were used for subtyping. PA patients treated with surgery or medication were followed up for 1 year, and outcomes after treatment were evaluated.

Results: In total, 1,020 newly diagnosed hypertensive patients were screened over 16 months, of whom 40 were diagnosed with PA, 948 with non-PA, 32 with probable PA, resulting in a prevalence of more than 4.0%. Compared with non-PA, PA patients more frequently displayed microalbuminuria (p = 0.031), but the incidence of cardiovascular events was not different (p = 0.927). For surgically treated patients (n = 7), a complete biochemical success rate was 100% and a complete clinical success rate was 85.7%. For medically treated patients (n = 29), the proportion with optimal blood pressure control was 79%, and among them, 91% (21 of 23) only needed 1 antihypertensive drug: the mineralocorticoid receptor antagonist.

Conclusions: The prevalence of PA in patients with newly diagnosed hypertension in China was at least 4%. PA screening in newly diagnosed hypertensive patients leads to good clinical outcomes. (Primary Aldosteronism In Hypertensive Patients in China [PA-China]; NCT03155139).

Keywords: clinical outcome; newly diagnosed hypertension; prevalence; primary aldosteronism.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Glands / diagnostic imaging*
  • Adrenal Glands / surgery
  • China / epidemiology
  • Female
  • Humans
  • Hyperaldosteronism* / blood
  • Hyperaldosteronism* / complications
  • Hyperaldosteronism* / epidemiology
  • Hyperaldosteronism* / therapy
  • Hypertension* / diagnosis
  • Hypertension* / epidemiology
  • Hypertension* / etiology
  • Hypertension* / therapy
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Patient Care Management* / methods
  • Patient Care Management* / statistics & numerical data
  • Prevalence
  • Prospective Studies
  • Tomography, X-Ray Computed / methods

Associated data

  • ClinicalTrials.gov/NCT03155139